Multiplanar bone anchor system

ABSTRACT

The present teachings provide one or more surgical implements for repairing damaged tissue, such as in the case of a spinal fixation procedure. A bone anchor is provided. The anchor can include a bone fastener. The bone fastener can include a head and a second end adapted to engage an anatomy. The bone fastener can extend along a longitudinal axis. The anchor can also include a coupling arrangement coupled to the head of the bone fastener so that the bone fastener is rotatable about the longitudinal axis to define a first plane of motion. The anchor can further include a saddle, which can be coupled to the coupling arrangement. The saddle can be movable relative to at least one of the bone fastener and the coupling arrangement to define a second plane of motion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/913,430 filed on Jun. 26, 2020, which is a continuation of U.S.patent application Ser. No. 15/682,167 filed on Aug. 21, 2017, andissued as U.S. Pat. No. 10,729,471 on Aug. 4, 2020, which is acontinuation of U.S. patent application Ser. No. 14/689,663 filed onApr. 17, 2015, and issued as U.S. Pat. No. 9,763,701 on Sep. 19, 2017,which is a continuation of U.S. patent application Ser. No. 13/103,069filed on May 8, 2011, and issued as U.S. Pat. No. 9,044,272 on Jun. 2,2015, which is a continuation-in-part of U.S. patent application Ser.No. 12/614,734 filed Nov. 9, 2009, and issued as U.S. Pat. No. 8,449,578on May 28, 2013, whereby the disclosures of the above applications areincorporated herein by reference.

INTRODUCTION

In general, the human musculoskeletal system is composed of a variety oftissues including bone, ligaments, cartilage, muscle, and tendons.Tissue damage or deformity stemming from trauma, pathologicaldegeneration, or congenital conditions often necessitates surgicalintervention to restore function. Surgical intervention can include anysurgical procedure that can restore function to the damaged tissue,which can require the use of one or more orthopedic prosthesis, such asorthopedic nails, screws, implants, etc., to restore function to thedamaged tissue.

Generally, in order to stabilize various boney tissue relative to oneanother, such as vertebrae of the spine, one or more implants can becoupled to each of the vertebrae and interconnected via a suitabledevice. In one example, implants or anchors can be coupled to each ofthe vertebrae, and a connecting device, such as a rod, can be coupled toeach of the anchors to stabilize or fix the vertebrae relative to eachother. In certain instances, it may be desirable to provide an anchorthat can move relative to the connecting device. The present teachingscan provide an anchor for use in repairing damaged tissue, such as abone anchor that can be movable in multiple planes for use in a fixationprocedure.

SUMMARY

Provided is a multiplanar bone anchor system for a fixation procedure.The system can include a bone fastener. The bone fastener can include ahead and a second end adapted to engage an anatomy. The bone fastenercan extend along a longitudinal axis. The system can also include acoupling arrangement coupled to the head of the bone fastener so thatthe bone fastener is rotatable about the longitudinal axis to define afirst plane of motion. The system can further include a saddle, whichcan be coupled to the coupling arrangement. The saddle can be movablerelative to at least one of the bone fastener and the couplingarrangement to define a second plane of motion.

Further provided is a multiplanar bone anchor system for a fixationprocedure. The system can include a bone fastener. The bone fastener caninclude a head and a second end adapted to engage an anatomy. The bonefastener can extend along a longitudinal axis. The system can alsoinclude a coupling arrangement, which can be coupled to the head of thebone fastener. The system can include a saddle. The saddle can include afirst portion and a second portion. The first portion can be movablerelative to the second portion along a first axis. The first axis can betransverse to the longitudinal axis of the bone fastener. The secondportion can be coupled to the coupling arrangement such that the bonefastener can pivot relative to the saddle about the head of the bonefastener.

Also provided is a multiplanar bone anchor system for a fixationprocedure. The system can include a bone fastener. The bone fastener caninclude a head and a second end adapted to engage an anatomy. The bonefastener can define a longitudinal axis. The system can also include aring coupled about the head of the bone fastener. The ring can includeat least one wing. The system can include a lock ring, which can have adistal end coupled to the head of the bone fastener. The system canfurther include a saddle. The saddle can include a first portion and asecond portion. The first portion of the saddle can be coupled to thesecond portion of the saddle so as to be movable relative to the secondportion. The second portion of the saddle can be coupled about the headof the bone fastener, the ring and at least a portion of the lock ring.The at least one wing of the ring can cooperate with the lock ring andthe second portion of the saddle to enable the bone fastener to pivotabout the head of the bone fastener. The at least one wing can alsocooperate with the second portion to enable the bone fastener to rotateabout the longitudinal axis.

According to various aspects, also provided is a bone anchor. The anchorcan include a bone fastener having a head including a first bearingsurface. The bone fastener can extend along a longitudinal axis. Theanchor can include a connecting arm defining a first bore having asecond bearing surface that cooperates with the first bearing surface ofthe bone fastener to enable the bone fastener to move relative to theconnecting arm. The connecting arm can include a first preferred angleslot that defines a preferred angle for the bone fastener to articulaterelative to the longitudinal axis. The anchor can include a saddlehaving a first member and a second member that cooperate to define asecond bore that extends along the longitudinal axis. The connecting armcan be received within the second bore such that the first member ismovable relative to the second member and the connecting arm in adirection transverse to the longitudinal axis.

Further provided is a bone anchor. The anchor can include a bonefastener having a head including a first bearing surface. The anchor canalso include a connecting arm having a first portion, a second portionand a first bore having a second bearing surface. The first portion caninclude at least one friction surface and the second portion can definea first preferred angle slot in communication with the first bore. Thehead of the bone fastener can be received within the first bore suchthat the first bearing surface of the head of the bone fastenercooperates with the second bearing surface of the first bore to enablethe bone fastener to move relative to the connecting arm. The anchor caninclude a saddle having a first member and a second member thatcooperate to define a second bore that extends along a longitudinalaxis. The connecting arm can be received within the second bore suchthat the first member is movable relative to the second member over theat least one friction surface.

Additionally, provided is a bone anchor. The anchor can include a bonefastener having a head including a hemispherical bearing surface. Theanchor can also include a connecting arm including a first portion, asecond portion and defining a first bore having a bearing surface thatcooperates with the hemispherical bearing surface of the bone fastenerto enable the bone fastener to move relative to the connecting arm. Thefirst portion can have opposed curved features that each including astraight portion. The second portion can include a first preferred angleslot. The anchor can include a saddle having a first member and a secondmember that cooperate to define a second bore that extends along thelongitudinal axis. The first member can be coupled to the first portionof the connecting arm such that the first member moves relative to theconnecting arm along the straight portions. The second member can becoupled to the second portion of the connecting arm and can define asecond preferred angle slot that cooperates with the first preferredangle slot to define a preferred angle for the bone fastener toarticulate relative to the longitudinal axis.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present teachings in any way.

FIG. 1 is a schematic environmental illustration of an exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 2 is a schematic perspective illustration of the multiplanar boneanchor system of FIG. 1 ;

FIG. 3 is a cross-sectional view of the multiplanar bone anchor systemof FIG. 2 , taken along line 3-3 of FIG. 2 ;

FIG. 4 is an exploded view of the multiplanar bone anchor system of FIG.1 ;

FIG. 5 is a perspective view of an exemplary portion of the multiplanarbone anchor system of FIG. 4 , which illustrates a first plane ofmotion;

FIG. 6 is a schematic perspective view of a second exemplary portion ofthe multiplanar bone anchor system of FIG. 2 moved about one of variousplanes of motion;

FIG. 7 is a second schematic perspective view of the second exemplaryportion of the multiplanar bone anchor system of FIG. 2 moved about oneof various planes of motion;

FIG. 8 is a schematic perspective view of the multiplanar bone anchorsystem of FIG. 2 in which a saddle associated with the multiplanar boneanchor system is moved about one of various planes of motion;

FIG. 9 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 10 is an exploded view of the multiplanar bone anchor system ofFIG. 9 ;

FIG. 11 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 9 , taken along line 11-11 of FIG. 9 ;

FIG. 12 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 13 is an exploded view of the multiplanar bone anchor system ofFIG. 12 ;

FIG. 14 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 12 , taken along line 14-14 of FIG. 12 ;

FIG. 15 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 16 is an exploded view of the multiplanar bone anchor system ofFIG. 15 ;

FIG. 17 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 15 , taken along line 17-17 of FIG. 15 ;

FIG. 18 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 19 is an exploded view of the multiplanar bone anchor system ofFIG. 18 ;

FIG. 20 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 18 , taken along line 20-20 of FIG. 18 ;

FIG. 21 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 22 is an exploded view of the multiplanar bone anchor system ofFIG. 21 ;

FIG. 23 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 21 , taken along line 23-23 of FIG. 21 ;

FIG. 24 is a schematic perspective illustration of another exemplarymultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 25 is an exploded view of the multiplanar bone anchor system ofFIG. 24 ;

FIG. 26 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 24 , taken along line 26-26 of FIG. 24 ;

FIG. 27 is a schematic exploded view of another exemplary multiplanarbone anchor system for use with a connecting device in a fixationprocedure according to the various teachings;

FIG. 28 is a schematic perspective illustration of an exemplary assemblyof a bone fastener and a multiplanar connecting system for use with amultiplanar bone anchor system according to the present teachings;

FIG. 29 is an exploded view of the assembly of FIG. 28 ;

FIG. 30 is a schematic, cross-sectional illustration of the assembly ofFIG. 28 , taken along line 30-30 of FIG. 28 ;

FIG. 31 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 32 is a schematic illustration of the exemplary multiplanar boneanchor system of FIG. 31 in one of various positions;

FIG. 33 is an exploded view of the multiplanar bone anchor system ofFIG. 31 ;

FIG. 34 is a perspective view of an exemplary connecting arm for usewith the multiplanar bone anchor system of FIG. 31 ;

FIG. 35 is a side view of the exemplary connecting arm of FIG. 34 ;

FIG. 36 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 31 , taken along line 36-36 of FIG. 31 ;

FIG. 37 is a perspective view of another exemplary connecting arm foruse with an exemplary multiplanar bone anchor system similar to themultiplanar bone anchor system of FIG. 31 ;

FIG. 38 is a side view of the exemplary connecting arm of FIG. 37 ;

FIG. 39 is a schematic cross-sectional illustration of an exemplarymultiplanar bone anchor system incorporating the connecting arm of FIG.37 ;

FIG. 40 is a perspective view of an exemplary multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 41 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 40 , taken along line 41-41 of FIG. 40 ;

FIG. 42 is a perspective view of an exemplary multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 43 is an exploded view of the multiplanar bone anchor system ofFIG. 42 ;

FIG. 44 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 42 ; taken along line 44-44 of FIG. 42 ;

FIG. 45 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 42 ; taken along line 45-45 of FIG. 42 ;

FIG. 46 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 47 is an exploded view of the multiplanar bone anchor system ofFIG. 46 ;

FIG. 48 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 46 , taken along line 48-48 of FIG. 46 ;

FIG. 49 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 46 , taken along line 49-49 of FIG. 46 ;

FIG. 50 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 51 is an exploded view of the multiplanar bone anchor system ofFIG. 50 ;

FIG. 52 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 50 , taken along line 52-52 of FIG. 50 ;

FIG. 53 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 50 , taken along line 53-53 of FIG. 50 ;

FIG. 54 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 55 is an exploded view of the multiplanar bone anchor system ofFIG. 54 ;

FIG. 56 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 54 , taken along line 56-56 of FIG. 54 ;

FIG. 57 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 54 , taken along line 57-57 of FIG. 54 ;

FIG. 58 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 59 is an exploded view of the multiplanar bone anchor system ofFIG. 58 ;

FIG. 60 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 58 , taken along line 60-60 of FIG. 58 ;

FIG. 61 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 58 , taken along line 61-61 of FIG. 58 ;

FIG. 62 is a schematic partial illustration of the multiplanar boneanchor system of FIG. 58 , illustrating an articulation of a bonefastener to a first greater angle;

FIG. 63 is a schematic cross-sectional illustration of the multiplanarbone anchor system of FIG. 58 , illustrating an articulation of the bonefastener to a second greater angle;

FIG. 64 is a perspective view of another exemplary multiplanar boneanchor system for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 65 is an exploded view of the multiplanar bone anchor system ofFIG. 64 ;

FIG. 66 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 64 , taken along line 66-66 of FIG. 64 ;

FIG. 67 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 64 , taken along line 67-67 of FIG. 64 ;

FIG. 68 is a perspective view of an exemplary multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 69 is an exploded view of the multiplanar bone anchor system ofFIG. 68 ;

FIG. 70 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 68 , taken along line 70-70 of FIG. 68 ;

FIG. 71 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 68 , taken along line 71-71 of FIG. 68 ;

FIG. 72 is a perspective view of an exemplary multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 73 is an exploded view of the multiplanar bone anchor system ofFIG. 72 ;

FIG. 74 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 72 , taken along line 74-74 of FIG. 72 ;

FIG. 75 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 72 , taken along line 75-75 of FIG. 72 ;

FIG. 76 is a perspective view of an exemplary multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 77 is an exploded view of the multiplanar bone anchor system ofFIG. 76 ;

FIG. 78 is a perspective view of a connecting arm for use with themultiplanar bone anchor system of FIG. 76 ;

FIG. 79 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 76 , taken along line 79-79 of FIG. 76 ;

FIG. 80 is a cross-sectional illustration of the multiplanar bone anchorsystem of FIG. 76 , taken along line 80-80 of FIG. 76 ;

FIG. 81 is a schematic environmental illustration of a lateral connectorfor use with a connecting device in a fixation procedure according tothe present teachings;

FIG. 82 is a perspective view of the lateral connector of FIG. 81 ;

FIG. 83 is a side view of the lateral connector of FIG. 81 ;

FIG. 84 is a cross-sectional illustration of the lateral connector ofFIG. 82 , taken along line 84-84 of FIG. 82 ;

FIG. 85 is a perspective view of a rod to rod or domino connector foruse with multiple connecting devices in a fixation procedure accordingto the present teachings;

FIG. 86 is a side view of the domino connector of FIG. 85 ;

FIG. 87 is a perspective view of a multiplanar bone anchor system foruse with a connecting device in a fixation procedure according to thepresent teachings;

FIG. 88 is a side view of the multiplanar bone anchor system of FIG. 87;

FIG. 89 is a perspective view of another multiplanar bone anchor systemfor use with a connecting device in a fixation procedure according tothe present teachings;

FIG. 90 is a side view of the multiplanar bone anchor system of FIG. 89;

FIG. 91 is a schematic illustration of the multiplanar bone anchorsystem of FIG. 89 in a second, translated position;

FIG. 92 is a schematic cross-sectional illustration of the multiplanarbone anchor system of FIG. 89 , taken along line 92-92 of FIG. 89 ,illustrating the multiplanar bone anchor system of FIG. 89 coupled to anexemplary portion of a bone plate;

FIG. 93 is a schematic illustration of another multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings in a first position;

FIG. 94 is a schematic illustration of the multiplanar bone anchorsystem of FIG. 93 in a second position;

FIG. 95 is a schematic illustration of another multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings in a first position;

FIG. 96 is a schematic, cross-sectional illustration of the multiplanarbone anchor system of FIG. 95 in a second position, taken along line96-96 of FIG. 95 ;

FIG. 97 is a schematic, side illustration of the multiplanar bone anchorsystem of FIG. 95 ;

FIG. 98 is a partially exploded schematic illustration of anothermultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 99 is a schematic illustration of the multiplanar bone anchorsystem of FIG. 98 assembled;

FIG. 100 is a partially exploded schematic illustration of anothermultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 101 is a perspective schematic illustration of the multiplanar boneanchor system of FIG. 100 ;

FIG. 102 is a partially exploded schematic illustration of anothermultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 103 is a schematic illustration of the multiplanar bone anchorsystem of FIG. 102 assembled;

FIG. 104 is a partially exploded schematic illustration of anothermultiplanar bone anchor system for use with a connecting device in afixation procedure according to the present teachings;

FIG. 105 is a perspective schematic illustration of the multiplanar boneanchor system of FIG. 104 ;

FIG. 106 is a schematic illustration of another multiplanar bone anchorsystem for use with a connecting device in a fixation procedureaccording to the present teachings;

FIG. 107 is a schematic, side illustration of the multiplanar boneanchor system of FIG. 106 in a second position;

FIG. 108 is a schematic environmental illustration of an exemplary bonefastener for use in a fixation procedure according to the presentteachings; and

FIG. 109 is a cross-sectional view of the bone fastener of FIG. 108 ,taken along line 109-109 of FIG. 108 .

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is notintended to limit the present teachings, application, or uses. It shouldbe understood that throughout the drawings, corresponding referencenumerals indicate like or corresponding parts and features. Although thefollowing description is related generally to a system for use in ananatomy to repair damaged tissue, such as in the case of spinal fusion,static spinal stabilization or dynamic spinal stabilization, it will beunderstood that the system as described and claimed herein can be usedin any appropriate surgical procedure, such as in a minimally invasiveorthopedic alignment or fixation procedure. Therefore, it will beunderstood that the following discussions are not intended to limit thescope of the present teachings and claims herein.

With reference to FIGS. 1-8 , a multiplanar bone anchor system 10 isshown. The multiplanar bone anchor system 10 may be particularly adaptedfor spinal fixation procedures. Various aspects of the presentteachings, however, may have application for other procedures. Incertain applications, the multiplanar bone anchor system 10 can becoupled to one or more vertebrae or vertebral bodies V (FIG. 1 ) in aposterior region of the spine. The multiplanar bone anchor system 10 caninclude a bone engaging member or bone fastener 12, a locking member orlock ring 14 (FIG. 3 ), a multiplanar coupling arrangement or system 16(FIG. 3 ) and a tulip head or saddle 18.

As will be discussed in greater detail herein, the multiplanar couplingsystem 16 can enable the saddle 18 to move relative to the bone fastener12 in multiple planes. Generally, the saddle 18 can be configured toreceive a connecting device or rod 20, which can be used to interconnectmultiple bone anchor systems 10 in an exemplary spinal fixationprocedure (FIG. 1 ). By using the multiplanar coupling system 16, thesaddle 18 can be moved relative to the bone fastener 12 in one or moreplanes to facilitate the connection of the connecting rod 20 to multiplebone anchor systems 10. In this regard, the vertebral bodies V of thepatient may be orientated in such a manner that each bone fastener 12,when coupled to a respective vertebral body V, may be slightly offsetfrom one another. By allowing the saddle 18 to move in multiple planesrelative to the bone fastener 12, the surgeon can move the saddles 18into alignment without regard to the placement of the bone fasteners 12.It should be noted, however, that although the multiplanar bone anchorsystem 10 is generally illustrated and described herein a singleassembly for use with a single connecting rod 20, any combination ofbone anchor systems 10 and connecting rods 20 can be employed during asurgical procedure.

For example, in a single level spinal fixation procedure, two boneanchor systems 10 can receive a single connecting rod 20. A multiplelevel spinal fixation procedure, however, will generally requireadditional bone anchor systems 10. In addition, the multiplanar boneanchor systems 10 need not be coupled to adjacent vertebral bodies V,but rather, the multiplanar bone anchor systems 10 can be positioned soas to skip adjacent vertebral bodies V, if desired.

With reference to FIGS. 2-4 , the bone fastener 12 can be configured toengage the anatomy to couple the multiplanar bone anchor system 10 tothe anatomy. The bone fastener 12 can be composed of any suitablebiocompatible material, such as titanium, stainless steel, biocompatiblepolymers, etc. The bone fastener 12 can include a proximal end or head30 (FIGS. 3 and 4 ) and a distal end or shank 32 (FIG. 2 ). Withreference to FIGS. 3 and 4 , the head 30 can be generally arcuate, andcan include a driver connection feature 34 and a channel 36. The driverconnection feature 34 can comprise any mating connection interface for adriver, such as a pentalobe, hexalobe, hexagon, torx, Philips, cruciate,straight, etc. Thus, the driver connection feature 34 can enable theapplication of a torque to drive the bone fastener 12 into the anatomy.

Briefly, it should be noted that particular tools for use with themultiplanar bone anchor system 10 are beyond the scope of the presentteachings and need not be described herein. In a conventional mannerinsofar as the present teachings are concerned, various tools can beused to connect the multiplanar bone anchor system 10 to a respectivevertebral body V. Exemplary tools can include those employed in thePolaris™ 5.5 Spinal System, commercially available from Biomet, Inc. ofWarsaw, Ind., or the tools disclosed in commonly owned U.S. PatentPublication No. 2008/0077138, filed on Apr. 20, 2007 and incorporated byreference herein.

With continued reference to FIGS. 3 and 4 , the channel 36 can bedefined about a circumference of the head 30. The channel 36 can receivea portion of the multiplanar coupling system 16 to enable the saddle 18to rotate about the longitudinal axis L of the bone fastener 12. Thus,the channel 36 can define a first bearing surface 36 a. It should benoted that although the bone fastener 12 is illustrated and describedherein as including the channel 36, the channel 36 need not be necessaryto enable the saddle 18 to rotate about the longitudinal axis L of thebone fastener 12.

With reference to FIG. 2 , the shank 32 of the bone fastener 12 caninclude a plurality of threads 32 a and at least one cutting flute 32 b.The at least one cutting flute 32 b can cooperate with the threads 32 ato cut into the anatomy, and thus, the bone fastener 12 does not requirea pre-tapped hole. It should be noted that although the bone fastener 12is illustrated and described herein as including at least one cuttingflute 32 b, the bone fastener 12 need not include any cutting flutes(requiring a pre-tapped hole), or could include multiple cutting flutes,if desired.

With reference to FIGS. 3 and 4 , the lock ring 14 can be positionedabout the head 30 of the bone fastener 12. As will be discussed herein,the lock ring 14 can lock at least one of the bone fastener 12 and themultiplanar coupling system 16 relative to the saddle 18 via a forceapplied by the connecting rod 20. The lock ring 14 can be generallycylindrical, and can have a height H. The height H can be sized toextend above a receiver surface 88 of the saddle 18 so that coupling theconnecting rod 20 to the saddle 18 can compress the lock ring 14 ontothe head 30 of the bone fastener 12. With reference to FIG. 4 , the lockring 14 can include a proximal end 40, a distal end 42, a bearingsurface 44, a slot 46 and a bore 48.

The proximal end 40 can include an annular projection 40 a. Withreference to FIG. 3 , the projection 40 a can have a diameter Dp, whichis larger than a diameter Dl of the lock ring 14. The larger diameter Dpof the projection 40 a can be sized to enable the lock ring 14 to moveor rotate about the head 30 of the bone fastener 12. With reference toFIGS. 3-5 , the distal end 42 can include a ring or flange 42 a and atleast one cutout 43. The flange 42 a can be formed about an exteriorsurface of the lock ring 14, and can retain the lock ring 14 within thesaddle 18, as will be discussed in detail herein. The at least onecutout 43 can be formed along a portion of a circumference of the lockring 14, and can be sized to cooperate with the multiplanar couplingsystem 16.

In one example, the lock ring 14 can include two cutouts 43, which canbe positioned on opposite sides of the lock ring 14 (FIG. 4 ). In thisexample, as best illustrated in FIG. 5 , the cutouts 43 can include afirst curved recess 43 a, a second curved recess 43 b and a third curvedrecess 43 c which can be congruent. The cutouts 43 can be generallysymmetrical about a longitudinal axis of the lock ring 14. The firstcurved recess 43 a and the third curved recess 43 c can be formed fromthe distal end 42 to the flange 42 a. The second curved recess 43 b canbe formed from the distal end 42 to a location adjacent to the flange 42a. In addition, the second curved recess 43 b can have a radius whichcan be greater than a radius associated with each of the first curvedrecess 43 a and the third curved recess 43 c.

With reference to FIGS. 3 and 4 , the bearing surface 44 can be formedon an interior surface of the lock ring 14. In one example, the bearingsurface 44 can be formed along an interior surface of the projection 40a at the distal end 42 of the lock ring 14. The bearing surface 44 cancomprise a generally concave region, which can extend from thecircumference of the projection 40 a. The bearing surface 44 can contacta portion of the head 30 to enable the lock ring 14 to move orarticulate relative to the bone fastener 12. The bearing surface 44 canalso enable the lock ring 14 to move or articulate relative to themultiplanar coupling system 16, as will be discussed herein.

With reference to FIG. 4 , the lock ring 14 can also include a slot 46.The slot 46 can extend through the projection 40 a, the proximal side 40and the distal end 42. The slot 46 can enable the lock ring 14 to becoupled about the head 30 of the bone fastener 12. Note, that the slot46 is optional, and the lock ring 14 could be continuous about thecircumference of the lock ring 14.

With reference to FIG. 3 , the bore 48 can be disposed about a centralaxis of the lock ring 14. The bore 48 can extend through the projection40 a, the proximal end 40 and the distal end 42. A first diameter D1 ofthe bore 48 at the projection 40 a can be substantially smaller than asecond diameter D2 of the bore 48 at the distal end 42 of the lock ring14. The bearing surface 44 can be formed about the bore 48, and cantransition the bore 48 from the first diameter D1 to the second diameterD2. The bore 48 can enable a driver to interface with the driverconnection feature 34 formed on the head 30 of the bone fastener 12.

In one example, the multiplanar coupling system 16 can include a ring50. The ring 50 can be disposed about a head 30 of the bone fastener 12to enable the bone fastener 12 to move or articulate relative to thesaddle 18, as shown in FIG. 3 . The ring 50 can be annular, and can besized to fit within the saddle 18 to enable the bone fastener 12 toarticulate relative to the saddle 18, as shown in FIGS. 6 and 7 . Withreference to FIG. 4 , the ring 50 can include a bore 52 and at least onewing 54. The bore 52 can be sized to enable the ring 50 to be coupled tothe channel 36 of the bone fastener 12, but can also be sized so as toprevent the ring 50 from migrating above the head 30 of the bonefastener 12, as best shown in FIG. 3 .

With reference to FIGS. 4 and 5 , at least one wing 54 can extendoutwardly from a circumference of the ring 50. In this example, the ring50 can include two wings 54. The wings 54 can extend outwardly fromopposite sides of the ring 50. The wings 54 can cooperate with thesaddle 18 to enable the bone fastener 12 to move or articulate relativeto the saddle 18 (FIG. 7 ). The wings 54 can include a first arcuatesurface 54 a, a second arcuate surface 54 b, a third arcuate surface 54c, a fourth arcuate surface 54 d, a fifth arcuate surface 54 e and asixth arcuate surface 54 f. It should be noted that the shape of thewings 54 described and illustrated herein is merely exemplary, as thewings 54 could have any shape that enables the bone fastener 12 torotate relative to the saddle 18, such as elliptical, circular, roundedsquare, rounded rectangular, etc.

The first arcuate surface 54 a can be opposite the fourth arcuatesurface 54 d, the second arcuate surface 54 b can be opposite the fiftharcuate surface 54 e and the third arcuate surface 54 c can be oppositethe sixth arcuate surface 54 f. Generally, the second arcuate surface 54b and the fifth arcuate surface 54 e can be positioned between the firstarcuate surface 54 a, fourth arcuate surface 54 d, third arcuate surface54 c and sixth arcuate surface 54 f. The first arcuate surface 54 a,second arcuate surface 54 b and the third arcuate surface 54 c can eachcontact one of the first curved recess 43 a, the second curved recess 43b, third curved recess 43 c, respectively, which can enable the lockring 14 to move or articulate relative to the ring 50, as best shown inFIG. 5 . The fourth arcuate surface 54 d, fifth arcuate surface 54 e andsixth arcuate surface 54 f can cooperate with the saddle 18 to enablethe bone fastener 12 to move or articulate relative to the saddle 18, asshown in FIGS. 6 and 7 .

With reference to FIGS. 4 and 6-8 , the saddle 18 can include a firstportion or bottom portion 60 and a second portion or top portion 62. Thetop portion 62 can move or translate relative to the bottom portion 60(FIG. 8 ). With reference to FIGS. 4 and 6-8 , the bottom portion 60 caninclude a first or proximal end 64, a second or distal end 66, a bore 68and a bearing surface 70. The proximal end 64 can be generallyrectangular, and can include rounded corners. The proximal end 64 can becoupled to the top portion 62 (FIG. 8 ). The proximal end 64 can defineat least one rail 64 a. Generally, the top portion 62 can move ortranslate along the at least one rail 64 a (FIG. 8 ). In one example,the proximal end 64 can define two rails 64 a, which can be positionedon opposite sides of the bottom portion 60. As will be discussed, thediameter Cap of the lock ring 14 can define or limit the translation ofthe top portion 62 relative to the bottom portion 60. The proximal end64 can taper to the distal end 66.

The distal end 66 can be adjacent to the shank 32 of the bone fastener12, when the saddle 18 is coupled to the bone fastener 12. As best shownin FIG. 3 , the distal end 66 can define a lip or stop 66 a on aninterior surface. In this example, the stop 66 a can extend into thebore 68 of the bottom portion 60. The stop 66 a can extend about acircumference of the bore 68, and can limit the motion or articulationof the bone fastener 12 relative to the saddle 18.

The bore 68 can be defined through the bottom portion 60. The bore 68can be sized to receive the ring 50, the lock ring 14 and the bonefastener 12 therein. With reference to FIG. 3 , the bore 68 can includebearing surface 68 a and a sidewall 68 b. The bearing surface 68 a canbe configured to receive the flange 42 a of the lock ring 14, to couplethe lock ring 14 to the saddle 18. In other words, the flange 42 a ofthe lock ring 14 can cooperate with the bearing surface 68 a of thebottom portion 60 to prevent the lock ring 14 from migrating out of thesaddle 18. The sidewall 68 b of the bore 68 can comprise a portion ofthe bearing surface 70.

The bearing surface 70 can be defined about a circumference of the bore68. In one example, the bearing surface 70 can be formed on a portion 70a of the stop 66 a, and a portion 70 b of the sidewall 68 b of the bore68. The bearing surface 70 can generally be shaped so as to cooperatewith the ring 50 to enable the ring 50 to move or articulate within thebottom portion 60 of the saddle 18, as best shown in FIG. 7 . Therelative movement between the ring 50 and the bottom portion 60 canallow the bone fastener 12 to pivot or angulate about a central axis orlongitudinal axis of the bone fastener 12.

With reference to FIGS. 3, 4 and 8 , the top portion 62 of the saddle 18can be coupled to the rails 64 a of the proximal end 64 of the bottomportion 60 so that the top portion 62 can move relative to the bottomportion 60. The top portion 62 can be substantially U-shaped andsymmetrical with respect to a longitudinal axis L2 defined by themultiplanar bone anchor system 10 (FIG. 8 ). The top portion 62 caninclude a first or proximal end 76 and a second or distal end 78. In oneexample, the proximal end 76 can include a first arm 80 and a second arm82. The first arm 80 and second arm 82 can extend upwardly from thedistal end 78 to define the U-shape. Each of the first arm 80 and thesecond arm 82 can include a mating portion 84 and a cavity 86.

The mating portion 84 can be configured to receive a fastening mechanismto couple the connecting rod 20 to the saddle 18. For example, themating portion 84 can comprise a plurality of threads, which can beformed on an interior surface 80 b, 82 b of each of the first arm 80 andsecond arm 82. In this example, the mating portion 84 can engage threadsformed on a set screw 22 to couple the connecting rod 20 to the saddle18 (FIG. 3 ). It should be noted, however, that the proximal end 76 canhave any suitable configuration to couple the connecting rod 20 to thesaddle 18, such as keyed portions, teeth, etc.

The cavity 86 can be defined in each interior surface 80 b, 82 b of thefirst arm 80 and second arm 82. The cavity 86 can provide clearance forthe movement or articulation of the top portion 62 relative to thebottom portion 60 of the saddle 18. In this regard, the cavity 86 can bedefined so as to allow the top portion 62 to move over a portion of thelock ring 14, which can provide a range of motion for the top portion 62relative to the bottom portion 60. Thus, contact between the lock ring14 and the cavity 86 can act as a stop to limit the movement ortranslation of the top portion 62 relative to the bottom portion 60,however, other techniques could be used to stop or limit the movement ortranslation of the top portion 62 relative to the bottom portion 60.

With reference to FIG. 4 , the distal end 78 of the top portion 62 canbe generally rectangular, and can include a first or a receiver surface88, a second or bottom surface 90 and a central bore 92. The receiversurface 88 can receive a portion of the connecting rod 20. In oneexample, the receiver surface 88 can comprise a generally arcuate,concave surface that forms the U-shape of the saddle 18, however, thereceiver surface 88 can comprise any desired shape, such as square, etc.

The bottom surface 90 can include at least one or more guides 90 a. Inthis example, the bottom surface 90 can include two guides 90 a. Theguides 90 a can slidably couple the top portion 62 to the bottom portion60. In this regard, each guide 90 a can cooperate with a respective oneof the rails 64 a to enable the top portion 62 of the saddle 18 to moveor translate relative to the bottom portion 60 of the saddle 18 (FIG. 8). Generally, each guide 90 a can comprise a C-shape, and each rail 64 acan be received within the guide 90 a. It should be understood, however,that any suitable shape could be used to enable the top portion 62 tomove or translate relative to the bottom portion 60.

The central bore 92 can be defined through the distal end 78 from thereceiver surface 88 to the bottom surface 90. Generally, the centralbore 92 can be sized to receive the bone fastener 12, and can cooperatewith the multiplanar coupling system 16 to allow the bone fastener 12 tomove in the desired planes.

With reference to FIGS. 2 and 3 , the connecting rod 20 can be receivedwithin the receiver surface 88 of the saddle 18. The connecting rod 20can be coupled to the saddle 18 via a suitable mechanical fastener, suchas the set screw 22. An exemplary connecting rod 20 and set screw 22 canbe substantially similar to the connecting rod and set screw employed inthe Polaris™ 5.5 Spinal System, commercially available from Biomet, Inc.of Warsaw, Ind., or the connecting element disclosed in commonly ownedU.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007 andpreviously incorporated by reference herein. As the connecting rod 20and the set screw 22 can be generally known, the connecting rod 20 andset screw 22 will not be discussed in great detail herein.

Briefly, however, the connecting rod 20 can comprise an elongated solidcylinder. The connecting rod 20 can also include a slight curvature,which can correspond to the natural curvature of the spine. Typically,the connecting rod 20 can be composed of a suitable biocompatiblematerial having sufficient rigidity to fix the vertebral bodies Vrelative to each other. The set screw 22 can include threads, which canmatingly engage the threads formed on the mating portion 84 of theproximal end 76 of the saddle 18.

With reference to FIGS. 4-8 , in order to assemble the multiplanar boneanchor system 10, the ring 50 can be positioned about the channel 36 ofthe bone fastener 12 (FIG. 5 ). Then, the bottom portion 60 of thesaddle 18 can be positioned about the ring 50 (FIGS. 6 and 7 ). The lockring 14 can be coupled to the top portion 62. Next, the top portion 62of the saddle 18 can be coupled to the bottom portion 60 of the saddle18 (FIG. 8 ) Then, the lock ring 14 can be coupled to the head 30 of thebone fastener 12.

Once assembled, the ring 50 can cooperate with the bottom portion 60 toenable movement or rotation of the bone fastener 12 about the central orlongitudinal axis of the bone fastener 12 (FIGS. 6 and 7 ). The lockring 14 can cooperate with the head 30 of the bone fastener 12 to enablethe bone fastener 12 to move or articulate relative to the saddle 18,about the head 30 of the bone fastener 12 (FIG. 5 ). The top portion 62of the saddle 18 can cooperate with the bottom portion 60 to enable thetop portion 62 of the saddle 18 to move or translate relative to thebottom portion 60 of the saddle 18 (FIG. 8 ). Thus, when assembled, themultiplanar bone anchor system 10 can have at least three degrees ofmovement or can be movable in at least three planes. By allowing themultiplanar bone anchor system 10 to move in at least three planes, thesurgeon can manipulate the multiplanar bone anchor system 10 asnecessary to conform to the anatomy of the patient.

With the bone fastener 12 coupled to the saddle 18 via the multiplanarcoupling system 16, surgical access can be made through the skin Sadjacent to the vertebral bodies V of interest (FIG. 1 ). The specificsurgical access approaches are beyond the scope of the presentapplication, but for example, surgical access can be obtained via aminimally invasive surgical procedure such as that used with thePolaris™ 5.5 Spinal System, commercially available from Biomet, Inc. ofWarsaw, Ind., or the minimally invasive surgical procedure disclosed incommonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr.20, 2007 and previously incorporated by reference herein.

Next, one or more multiplanar bone anchor systems 10 can be coupled to arespective vertebral body V via the bone fastener 12 (FIG. 1 ). Varioustechniques can be used to couple the multiplanar bone anchor systems 10to the anatomy, such as those described in commonly owned U.S. PatentPublication No. 2008/0077138, filed on Apr. 20, 2007, previouslyincorporated by reference herein. In one example, if each bone fastener12 includes the driver connection feature 34 defined in the head 30, asuitable tool can be coupled to the driver connection feature 34 todrive the bone fastener 12 into the anatomy in a conventional manner.Once the multiplanar bone anchor systems 10 are coupled to the anatomy,the connecting rod 20 can be inserted into the saddle 18 of each of themultiplanar bone anchor systems 10. Generally, the connecting rod 20 canbe inserted such that the connecting rod 20 rests on the receiversurface 88 of the distal end 78 of the saddle 18 (FIG. 2 ).

With the connecting rod 20 positioned in the saddles 18 of themultiplanar bone anchor systems 10, the set screw 22 can be coupled toeach mating portion 84 of each saddle 18 (FIG. 3 ). The coupling of theset screw 22 can apply a force to the lock ring 14 to fixedly couple orlock the position of the bone fastener 12 relative to the saddle 18. Inthis regard, the lock ring 14 can apply a force to the head 30 of thebone fastener 12, which in turn, can provide a force on the ring 50.Additionally, the lock ring 14 can apply a force directly to the ring50. The force on the ring 50, can in turn be applied to the bottomportion 60 of the saddle 18 to thereby fix the position of the bonefastener 12 relative to the saddle 18.

With reference now to FIGS. 9-11 , in one example, a multiplanar boneanchor system 100 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 100can be similar to the multiplanar bone anchor system 10 described withreference to FIGS. 1-8 , only the differences between the multiplanarbone anchor system 10 and the multiplanar bone anchor system 100 will bediscussed in great detail herein, and the same reference numerals willbe used to denote the same or similar components. The multiplanar boneanchor system 100 can include a bone fastener 102, a multiplanarcoupling arrangement or system 104 and a saddle 106. It should be noted,that although the multiplanar bone anchor system 100 is described andillustrated herein as not including a lock ring 14, a suitable lock ring14 could be employed with the multiplanar bone anchor system 100, ifdesired.

With continued reference to FIGS. 9-11 , the bone fastener 102 can beconfigured to engage the anatomy to couple the multiplanar bone anchorsystem 100 to the anatomy. The bone fastener 102 can be composed of anysuitable biocompatible material, such as titanium, stainless steel,biocompatible polymers, etc. The bone fastener 102 can include a head108 and the shank 32. The head 108 can be generally arcuate, and caninclude the driver connection feature 34 and a channel 108 a.

The channel 108 a can be defined about a circumference of the head 108,generally between the head 108 and the shank 32. The channel 108 a canreceive a portion of the multiplanar coupling system 104 to enable thesaddle 106 to rotate about the longitudinal axis L of the bone fastener102 (FIG. 10 ). Thus, the channel 108 a can define a first bearingsurface. It should be noted that although the bone fastener 102 isillustrated and described herein as including the channel 108 a, thechannel 108 a need not be necessary to enable the saddle 106 to rotateabout the longitudinal axis L of the bone fastener 102.

In one example, with continued reference to FIGS. 9-11 , the multiplanarcoupling system 104 can include a connecting arm 110 and a bearingmember or ring 112. The connecting arm 110 and the ring 112 cancooperate with the bone fastener 102 to enable the bone fastener 102 tomove relative to the saddle 106. The connecting arm 110 can be disposedabout a head 108 of the bone fastener 102 to enable the bone fastener102 to move or articulate relative to the saddle 106 as shown in FIG. 11. In this example, the connecting arm 110 can be annular, and can becoupled to the saddle 106. The connecting arm 110 can include a bore114. The bore 114 can be formed about a central axis C of the connectingarm 110. As best shown in FIG. 11 , the bore 114 can include a matingportion 114 a, a recess 114 b, a coupling portion 114 c and a taperedportion 114 d.

The mating portion 114 a can couple the connecting arm 110 to the saddle106. It should be noted that the mating portion 114 a can be configuredso that the saddle 106 can move or translate relative to the connectingarm 110. For example, the mating portion 114 a can comprise opposingguides or slots formed through a portion of the connecting arm 110 thatcan slidably receive a portion of the saddle 106. It should be noted,however, any suitable method or configuration can be used to slidablycouple the saddle 106 to the connecting arm 110, such as a dovetail,rails, etc.

The recess 114 b can be defined between the mating portion 114 a and theat least one coupling portion 114 c. Generally, the recess 114 b can bearcuate, and in one example, can be hemispherical. The recess 114 b canprovide at least clearance for the rotation of the head 108 of the bonefastener 102 within and relative to the connecting arm 110. In thisregard, the recess 114 b can be sized to enable at least rotation aboutthe longitudinal axis L of the bone fastener 102, and can also be sizedto enable rotation of the connecting arm 110 relative to the head 108 ofthe bone fastener 102, if desired.

The coupling portion 114 c can be defined between the recess 114 b andthe tapered portion 114 d. In one example, the coupling portion 114 ccan comprise a channel defined about the circumference of the connectingarm 110. Generally, the coupling portion 114 c can be configured toreceive the ring 112, which can movably or rotatably couple the bonefastener 102 to the connecting arm 110, as will be discussed herein.

The tapered portion 114 d can be defined at a distal most end of thebore 114. The tapered portion 114 d can provide clearance for theangular movement of the bone fastener 102 relative to the saddle 106. Inthis regard, the tapered portion 114 d can be formed about acircumference of the bore 114, and the shank 32 of the bone fastener 102can contact the tapered portion 114 d to limit the angular motion of thebone fastener relative to the connecting arm 110. Thus, the taperedportion 114 d can provide a stop or limit for the angular movement ofthe bone fastener 102 relative to the saddle 106.

With reference to FIGS. 10 and 11 , the ring 112 can be coupled to thechannel 108 a of the head 108 of the bone fastener 102, and cancooperate with the bore 114 to enable the bone fastener 102 to move orrotate relative to the connecting arm 110. In one example, the ring 112can comprise a generally C-shape body, and can have a slot 112 a. Thering 112 can be at least partially received within the channel 108 a ofthe head 108. Generally, the ring 112 can be snap-fit into the channel108 a of the bone fastener 102. In one example, the ring 112 can have aninner diameter which can be greater than an outer diameter of thechannel 108 a of the head 108 to prevent separation of the ring 112 fromabout the head 108 of the bone fastener 102. It should be noted,however, that the ring 112 could have a continuous annular body, such asan O-shape, and in this case, the ring 112 could be threaded over theshank 32 into the channel 36.

With reference to FIG. 10 , the ring 112 can include at least one wing116. The at least one wing 116 can extend outward from the body of thering 112 to engage the coupling portion 114 c of the bore 114. In thisexample, the ring 112 can include two wings 116, which can each bereceived within and slidably coupled to the coupling portion 114 c ofthe bore 114 of the connecting arm 110. The wings 116 can comprisebearing surfaces, which can cooperate with the coupling portion 114 c toenable the rotation of the bone fastener 102 about the connecting arm110. Thus, the wings 116 can have any shape, which can enable the wings116 to move or slide within the coupling portion 114 c of the bore 114,such as elliptical, spherical, rounded, annular, rounded square, roundedrectangular, etc. The wings 116 can also include at least one taperedsurface 116 a, which can enable the connecting arm 110 to move or pivotrelative to the bone fastener 102. In this example, the wings 116 caninclude two opposed tapered surfaces 116 a, which can cooperate with thecoupling portion 114 c to enable the connecting arm 110 to move or pivotabout the head 108 of the bone fastener 102.

With reference to FIGS. 9-11 , the saddle 106 can be coupled to themultiplanar coupling system 104 via the connecting arm 110. Generally,the saddle 106 can be coupled to the connecting arm 110 so that thesaddle 106 can move or translate relative to the multiplanar couplingsystem 104 and the bone fastener 102. The saddle 106 can besubstantially U-shaped and symmetrical with respect to a longitudinalaxis L defined by the multiplanar bone anchor system 100. In oneexample, the saddle 106 can include a first or proximal end 120 and asecond or distal end 122. In one example, the proximal end 120 caninclude a first arm 124 and a second arm 126. The first arm 124 andsecond arm 126 can extend upwardly from the distal end 122 to define theU-shape. Each of the first arm 124 and the second arm 126 can includethe mating portion 84.

With reference to FIGS. 10 and 11 , the distal end 122 can be generallyrectangular, and can include the receiver surface 88 (FIG. 10 ), atleast one rail 122 a (FIG. 11 ) and the central bore 92 (FIG. 11 ). Inone example, the distal end 122 can include two rails 122 a. Generally,the rails 122 a can be formed on opposite sides of the bore 92, and canextend outwardly from the bore 92. The rails 122 a can slidably couplethe saddle 106 to the connecting arm 110. In this regard, each rail 122a can cooperate with a respective one of the guides or slots of themating portion 114 a to enable the saddle 106 to move or translaterelative to the connecting arm 110 and bone fastener 102. It should beunderstood, however, that any suitable mechanism could be used to enablethe saddle 106 to move or translate relative to the connecting arm 110,such as a dovetail assembly, etc. Further, the distal end 122 couldinclude only one rail 122 a, if desired. It should also be understoodthat the saddle 106 could include the mating portion 114 a and the rails122 a could be formed on the connecting arm 110 to enable the relativemotion between the saddle 106 and the connecting arm 110, if desired.

With reference to FIGS. 10 and 11 , in order to assemble the multiplanarbone anchor system 100, the ring 112 can be coupled to the channel 108 aof the bone fastener 102. Then, the connecting arm 110 can be coupled tothe ring 112 such that the wings 116 of the ring 112 are received withinthe coupling portion 114 c of the connecting arm 110. The saddle 106 canbe positioned so that the rails 122 a are slidably coupled to the matingportion 114 a of the connecting arm 110.

Once assembled, the connecting arm 110 can cooperate with the ring 112to enable movement or rotation of the bone fastener 102 about thecentral or longitudinal axis of the bone fastener 102, which provides afirst plane of motion. In addition, the tapered surfaces 116 a of thewings 116 can cooperate with the coupling portion 114 c of theconnecting arm 110 to enable the connecting arm 110 to move or pivotrelative to the bone fastener 102, about the head 108 of the bonefastener 102, thereby providing a second plane of motion. The saddle 106can also cooperate with the connecting arm 110 to enable the saddle 106to move or translate relative to the connecting arm 110, which canprovide a third plane of motion. Thus, when assembled, the multiplanarbone anchor system 100 can have at least three planes or degrees ofmotion. By allowing the multiplanar bone anchor system 100 to move in atleast three planes, the surgeon can manipulate the multiplanar boneanchor system 100 as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system100 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 100 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 100 is secured to theanatomy, the multiplanar coupling system 104 and the saddle 106 can bemoved, pivoted or rotated relative to the bone fastener 102 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be coupled to a desired number of multiplanar boneanchor systems 100.

With reference now to FIGS. 12-14 , in one example, a multiplanar boneanchor system 200 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 200can be similar to the multiplanar bone anchor system 100 described withreference to FIGS. 9-11 , only the differences between the multiplanarbone anchor system 100 and the multiplanar bone anchor system 200 willbe discussed in great detail herein, and the same reference numeralswill be used to denote the same or similar components. The multiplanarbone anchor system 200 can include the bone fastener 102, a multiplanarcoupling arrangement or system 204 and a saddle 206.

With reference to FIGS. 12-14 , the multiplanar coupling system 204 caninclude a connecting arm 210, at least one plug 215 and a retaining ring216. The connecting arm 210 can cooperate with the bone fastener 102 toenable the bone fastener 102 to move relative to the saddle 206. Theconnecting arm 210 can be disposed about a head 108 of the bone fastener102 to enable the bone fastener 102 to move or articulate relative tothe saddle 206. In this example, the connecting arm 210 can be annular,and can be coupled to the saddle 206. The connecting arm 210 can includeat least one coupling feature 213 and a bore 214. The at least onecoupling feature 213 can comprise two coupling features 213. In thisexample, the coupling features 213 can comprise bores, which can bedefined through opposite sides of the connecting arm 210 to the bore214. The bore 214 can be formed about a central axis C of the connectingarm 210. As best shown in FIG. 14 , the bore 214 can include a matingportion 214 a, the coupling portion 114 c and the tapered portion 114 d.

The mating portion 214 a can cooperate with the retaining ring 216 tocouple the connecting arm 210 to the saddle 206. Generally, the matingportion 214 a can be configured so that the saddle 206 can move relativeto the connecting arm about via the retaining ring 216. In this example,the mating portion 214 a can comprise opposing guides or slots formedthrough a portion of the connecting arm 210, which can slidably receivea portion of the retaining ring 216. It should be noted, however, anysuitable method or configuration can be used to movably couple thesaddle 206 to the connecting arm 210, such as a dovetail, rails, etc.

With reference to FIG. 13 , in one example, the at least one plug 215 acan comprise two plugs 215 a. The plugs 215 a can engage the couplingportion 114 c of the bore 214. In this example, each of the plugs 215 acan be received within and slidably coupled to the coupling portion 114c of the bore 214 of the connecting arm 210. The plugs 215 a cancomprise bearing surfaces, which can cooperate with the coupling portion114 c to enable the rotation of the bone fastener 102 about theconnecting arm 210. Thus, the plugs 215 a can have any shape, which canenable the plugs 215 a to move or slide within the coupling portion 114c of the bore 114, such as elliptical, spherical, rounded, annular,rounded square, rounded rectangular, etc. In one example, the plugs 215a can each include a cut out (or similar features) 215 b, which canenable the plugs 215 a to be snap-fit or press-fit into the connectingarm 210. It should be understood, however, that the plugs 215 a could beintegrally formed with the connecting arm 210, if desired. The plugs 215a can cooperate with the coupling portion 114 c to enable the connectingarm 210 to move or pivot about the head 108 of the bone fastener 102.

As best shown in FIG. 14 , the retaining ring 216 can couple the saddle206 to the connecting arm 210. In this regard, the retaining ring 216can include a first or proximal end 218 and a second or distal end 220.The proximal end 218 can be coupled to a portion of the saddle 206, aswill be discussed, and the distal end 220 can be coupled to the matingportion 214 a of the connecting arm 210. The retaining ring 216 cancomprise any suitable structure, such as an annular ring, which may ormay not include a continuous, uninterrupted circumference. In thisexample, the retaining ring 216 can comprise a C-shaped ring, however,it should be understood that the retaining ring 216 could also comprisea non-annular structure, such as a rectangular structure, squarestructure, etc.

The proximal end 218 of the retaining ring 216 can include a projection218 a, which can couple the proximal end 218 to the saddle 206. Thedistal end 220 can also include a projection 220 a, which can couple thedistal end 220 to the mating portion 214 a. The projection 220 a of thedistal end 220 can also include a recess 220 b, as best shown in FIG. 14. The recess 220 b can allow the head 108 of the bone fastener 102 torotate about the connecting arm 210 without contacting the retainingring 216.

The saddle 206 can be coupled to the connecting arm 210 via theretaining ring 216. Generally, the saddle 206 can be coupled to theconnecting arm 210 so that the saddle 206 can move or rotate relative tothe multiplanar coupling system 204 and the bone fastener 102. Thesaddle 206 can be substantially U-shaped and symmetrical with respect toa longitudinal axis L defined by the multiplanar bone anchor system 200(FIG. 14 ). In one example, the saddle 206 can include the first orproximal end 120 and a second or distal end 224.

With reference to FIG. 14 , the distal end 224 can be generally annular,and can include the receiver surface 88, at least one channel 224 a andthe central bore 92. In this example, the distal end 224 can include twochannels 224 a. Generally, the channels 224 a can be formed on oppositesides of the bore 92. The channels 224 a can couple the saddle 206 tothe connecting arm 210. In this regard, the channels 224 a can receivethe projection 220 a of the distal end 220 of the retaining ring 216 tocouple the saddle 206 to the connecting arm 210 and bone fastener 102.

With reference to FIGS. 13 and 14 , in order to assemble the multiplanarbone anchor system 200, the retaining ring 216 can be coupled to thechannels 224 a of the saddle 206. With the retaining ring 216 coupled tothe saddle 206, the distal end 220 of the retaining ring 216 can bepushed into the connecting arm 210, such that the projection 220 a ofthe retaining ring 216 fits within the mating portion 214 a of theconnecting arm 210. Then, the connecting arm 210 can be positioned overthe bone fastener 102, and the plugs 215 a can be coupled to theconnecting arm 210 so that the plugs 215 a are received through thecoupling features 213 of the connecting arm 210.

Once assembled, the connecting arm 210 can cooperate with the plugs 215a to enable movement or rotation of the bone fastener 102 about thecentral or longitudinal axis of the bone fastener 102, which provides afirst plane of motion. In addition, the plugs 215 a can cooperate withthe coupling portion 114 c of the connecting arm 210 to enable theconnecting arm 210 to move or pivot relative to the bone fastener 102,about the head 108 of the bone fastener 102, thereby providing a secondplane of motion. The saddle 206 can also cooperate with the connectingarm 210 via the retaining ring 216 to enable the saddle 206 to move orrotate relative to the connecting arm 210, which can provide a thirdplane of motion. Thus, when assembled, the multiplanar bone anchorsystem 200 can have at least three planes or degrees of motion. Byallowing the multiplanar bone anchor system 200 to move in at leastthree planes, the surgeon can manipulate the multiplanar bone anchorsystem 200 as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system200 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 100 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 200 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 200 is secured to theanatomy, the multiplanar coupling system 204 and the saddle 206 can bemoved, pivoted or rotated relative to the bone fastener 102 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be coupled to a desired number of multiplanar boneanchor systems 200.

With reference now to FIGS. 15-17 , in one example, a multiplanar boneanchor system 300 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 300can be similar to the multiplanar bone anchor system 10 described withreference to FIGS. 1-9 , only the differences between the multiplanarbone anchor system 300 and the multiplanar bone anchor system 10 will bediscussed in great detail herein, and the same reference numerals willbe used to denote the same or similar components. The multiplanar boneanchor system 300 can include a bone fastener 302, a lock ring 304, amultiplanar coupling arrangement or system 306 and a saddle 307.

With reference to FIGS. 15 and 16 , the bone fastener 302 can beconfigured to engage the anatomy to couple the multiplanar bone anchorsystem 300 to the anatomy. The bone fastener 302 can be composed of anysuitable biocompatible material, such as titanium, stainless steel,biocompatible polymers, etc. The bone fastener 302 can include aproximal end or head 308 and the distal end or shank 32. The head 308can include a generally arcuate or hemispherical portion 308 a coupledto the shank 32 via a shaft 308 b. The hemispherical portion 308 a caninclude the driver connection feature 34. The hemispherical portion 308a can be coupled to the lock ring 304 when the multiplanar bone anchorsystem 300 is assembled. The shaft 308 b can be generally cylindrical,and can extend distally from the hemispherical portion 308 a. The shaft308 b can receive a portion of the multiplanar coupling system 306 tocouple the multiplanar coupling system 306 to the bone fastener 302.

The lock ring 304 can be positioned about the head 308 of the bonefastener 302, as best shown in FIG. 17 . The lock ring 304 can couple orlock the bone fastener 302 relative to the multiplanar coupling system306 via a force applied by the connecting rod 20, as will be discussedherein. The lock ring 304 can be generally cylindrical, and can have aheight H3. The height H3 can be sized to extend above or about equal toa receiver surface 88 of the saddle 307 so that coupling the connectingrod 20 to the saddle 307 can compress the lock ring 304 onto the head308 of the bone fastener 302. In this example, as shown in FIG. 16 , thelock ring 304 can include a cut out 304 a, which can facilitatepositioning the lock ring 304 about the head 308 of the bone fastener302. It should be understood, however, that the cut out 304 a can beoptional, as the lock ring 304 can have a continuous, uninterruptedcylindrical body. In addition, the lock ring 304 can include a proximalend 310, a distal end 312, a flange 314 and a bore 316.

The proximal end 310 can extend above the receiver surface 88 of thesaddle 307 when the multiplanar bone anchor system 300 is assembled. Theproximal end 310 can contact at least a portion of the connecting rod 20when the connecting rod 20 is coupled to the multiplanar bone anchorsystem 300. The distal end 312 can be coupled to the hemisphericalportion 308 a of the head 308 of the bone fastener 302 when the lockring 304 is coupled to bone fastener 302. The distal end 312 can includeat least one cut-out or recess 312 a. In one example, the distal end 312can include two recesses 312 a, 312 b. The recesses 312 a and 312 b canprovide clearance for a portion of the multiplanar coupling system 306.Optionally, the recesses 312 a and 312 b can enable the bone fastener302 to move or pivot about the head 308 of the bone fastener 302, asdiscussed with regard to FIGS. 1-9 .

The flange 314 can be formed between the proximal end 310 and the distalend 312, and can extend outwardly about an exterior circumference of thelock ring 304. The flange 314 can cooperate with a portion of themultiplanar coupling system 306 to couple or retain the lock ring 304within the multiplanar coupling system 306.

The bore 316 can be disposed about a central axis of the lock ring 304.The bore 316 can extend from the proximal end 310 to the distal end 312.The bore 316 can include a first countersink 316 a formed near or at theproximal end 310 and a second countersink 316 b formed near or at thedistal end 312. The first countersink 316 a can be configured to atleast partially receive a portion of the connecting rod 20 when theconnecting rod 20 is coupled to the multiplanar bone anchor system 300.The second countersink 316 b can comprise a bearing surface, which canbe slidably coupled to the head 308 of the bone fastener 302. Generally,the second countersink 316 b can enable the head 308 to move, rotateand/or pivot relative to the lock ring 304.

The multiplanar coupling system 306 can include a connecting arm 320 anda ring 322. The connecting arm 320 can cooperate with the bone fastener302 to enable the bone fastener 302 to move relative to the saddle 307.It should be noted that although the multiplanar coupling system 306 isdescribed and illustrated herein as including the connecting arm 320 andthe ring 322, the multiplanar coupling system 306 could include only aring or only a connecting arm, if desired. In this example, theconnecting arm 320 can have a first shell half 324 and a second shellhalf 326, which can cooperate to form a substantially continuous annularor cylindrical body having a bore 320 a when assembled together (FIG. 17). Each of the first shell half 324 and the second shell half 326 caninclude a flange 328, a channel 330, at least one mating feature 332, astop 334, a ring retaining portion 336 and a lock ring retaining portion338. Generally, each of the flange 328 and the channel 330 can be formedon an exterior surface of each of the first shell half 324 and thesecond shell half 326, while the stop 334, the ring coupling portion 336and the lock ring retaining portion 338 can be formed on an interiorsurface of the first shell half 324 and the second shell half 326.

With reference to FIG. 16 , the flange 328 can be defined at a proximalend 324 a, 326 a of the first shell half 324 and the second shell half326. The flange 328 can have a smaller diameter than the body of thefirst shell half 324 and the second shell half 326. The flange 328 cancooperate with the channel 330 to couple a portion of the saddle 307 tothe connecting arm 320. The channel 330 can be defined adjacent to theflange 328. The channel 330 can have a diameter that can be smaller thanthe flange 328. As will be discussed, the flange 328 and the channel 330can cooperate to rotatably couple a portion of the saddle 307 to theconnecting arm 320.

With continued reference to FIG. 16 , the at least one mating feature332 can couple the first shell half 324 and the second shell half 326together. In one example, the at least one mating feature 332 cancomprise two mating features 332, however, it should be understood thatany number of mating features could be employed to couple the firstshell half 324 to the second shell half 326. For example, a matingportion 332 a of the first shell half 324 can comprise a plug, and amating portion 332 b of the second shell half 326 can comprise areceiver. It should be noted that the use of a plug and a receiver ismerely exemplary as any suitable technique could be used to couple thefirst shell half 324 to the second shell half 326, such as adhesives,mechanical fasteners, welding, etc. When the first shell half 324 andthe second shell half 326 are coupled together via the mating portions332, the first shell half 324 and the second shell half 326 can definethe bore 320 a. The stop 334, the ring coupling portion 336 and the lockring coupling portion 338 can generally be defined within the bore 320a.

The stop 334 can comprise a tapered portion, which can be formed near orat a distal end 324 b, 326 b of the first shell half 324 and the secondshell half 326. The stop 334 can serve to limit the range of motion ofthe bone fastener 302 relative to the connecting arm 320. The ringcoupling portion 336 can be defined between the proximal end 324 a, 326a and the distal end 324 b, 326 b. In one example, the ring couplingportion 336 can comprise a bore 336 a. The bore 336 a of the ringcoupling portion 336 can receive a portion of the ring 322 to couple thering 322 to the connecting arm 320, as will be discussed in detailfurther herein.

The lock ring retaining portion 338 can be defined between the proximalend 324 a, 326 a and the ring coupling portion 336 of the first shellhalf 324 and the second shell half 326. The lock ring retaining portion338 can include a bearing surface 338 a. The bearing surface 338 a canbe defined radially about the interior of the first shell half 324 andthe second shell half 326, such that when the first shell half 324 iscoupled to the second shell half 326, the bearing surface 338 a canextend circumferentially about the bore 320 a. The bearing surface 338 acan be configured to receive at least a portion of the flange 314 of thelock ring 304 to couple the lock ring 304 to the connecting arm 320.

The ring 322 can be coupled to the connecting arm 320 via the ringcoupling portion 336. The ring 322 can be disposed about the head 308 ofthe bone fastener 302 to enable the bone fastener 302 to move or rotaterelative to the saddle 307. The ring 322 can be annular, and can besized to fit within the connecting arm 320 to enable the connecting arm320 to move or rotate with the bone fastener 302 relative to the saddle307. The ring 322 can include a bore 340 and at least one wing 342. Thebore 340 can be sized to enable the ring 322 to be coupled about theshaft 308 b of the bone fastener 302, but can also be sized so as toprevent the ring 322 from migrating onto the hemispherical portion 308 aof the head 308 of the bone fastener 302.

The at least one wing 342 can extend outwardly from a circumference ofthe ring 322. In this example, the at least one wing 342 can comprisetwo wings 342. The wings 342 can extend outwardly from generallyopposite sides of the ring 322. The wings 342 can be generallycylindrical in shape, and can be sized to be coupled to or receivedwithin the bore 336 a of the ring coupling portion 336. It should benoted that the shape of the wings 342 described and illustrated hereinis merely exemplary, as the wings 342 could have any shape that enablesthe bone fastener 302 to be coupled to the connecting arm 320, such aselliptical, circular, rounded square, rounded rectangular, etc. Thewings 342 can couple the ring 322 to the connecting arm 320 so that theconnecting arm 320 can rotate with the bone fastener 302 relative to thesaddle 307.

With reference to FIGS. 16 and 17 , the saddle 307 can be coupled to themultiplanar coupling system 306 via the connecting arm 320. Generally,the saddle 307 can be coupled to the connecting arm 320 so that theconnecting arm 320 can move or rotate relative to the saddle 307, and sothat the saddle 307 can move or translate relative to the multiplanarcoupling system 306 and the bone fastener 302.

The saddle 307 can be substantially U-shaped and symmetrical withrespect to a longitudinal axis L defined by the multiplanar bone anchorsystem 300 (FIG. 17 ). The saddle 307 can include a first portion orbottom portion 350, and a second portion or top portion 352. The topportion 352 can move or translate relative to the bottom portion 350.

In this regard, with reference to FIGS. 16 and 17 , the bottom portion350 of the saddle 307 can be generally annular or cylindrical in shape,and can comprise a proximal end 354, a distal end 356 and a bore 358.The bottom portion 350 can also include a cut out 350 a, if desired,which can facilitate coupling the bottom portion 350 to the connectingarm 320. It should be noted, that the cut out 350 a is optional, as thebottom portion 350 could be coupled to the connecting arm 320 via othertechniques, such as a snap-fit, press-fit, etc. The proximal end 354 canbe coupled to the top portion 352 of the saddle 307, while the distalend 356 can be coupled to the connecting arm 320. The bore 358 can besized to allow at least a portion of the proximal end 310 of the lockring 304 to pass there through. As will be discussed, the bore 358 canalso be configured to receive a portion of the connecting arm 320therein, when the connecting arm 320 is coupled to the bottom portion350.

In one example, the proximal end 354 of the bottom portion 350 candefine at least one rail 360, which can cooperate with the top portion352 of the saddle 307 to enable the saddle 307 to move or translaterelative to the connecting arm 320. In this example, the proximal end354 can define two rails 360 a, 360 b, which can be disposed ongenerally opposite sides of the bore 358. In on example, the rails 360a, 360 b can extend along a plane generally perpendicular to thelongitudinal axis L of the multiplanar bone anchor system 300, however,it should be understood that the rails 360 a. 360 b can extend in anydesired plane or in multiple planes. The rails 360 a, 360 b can enablethe saddle 307 to move, translate or slide along the proximal end 354 ofthe bottom portion 350.

The distal end 356 of the bottom portion 350 can define a lip 356 a. Thelip 356 a can extend about the circumference of the bottom portion 350.The lip 356 a can project into the bore 358, and can couple the distalend 356 of the bottom portion 350 to the connecting arm 320. In thisregard, the lip 356 a can be configured to be coupled to the flange 328of the connecting arm 320. The engagement of the lip 356 a with theflange 328 can allow the connecting arm 320 to move or rotate with thebone fastener 302, relative to at least the top portion 352 of thesaddle 307, as will be discussed further herein.

The top portion 352 of the saddle 307 can be coupled to the rails 360 a,360 b of the proximal end 354 of the bottom portion 350 so that the topportion 352 can move relative to the bottom portion 350. The top portion352 can be substantially U-shaped and symmetrical with respect to alongitudinal axis L defined by the multiplanar bone anchor system 300.The top portion 352 can include the first or proximal end 76 and asecond or distal end 370.

With reference to FIG. 17 , the distal end 370 of the top portion 352can be generally rectangular, and can include the first or receiversurface 88, a second or bottom surface 372 and a central bore 374. Thebottom surface 372 can include at least one or more guides 372 a. Inthis example, the bottom surface 90 can include two guides 372 a, 372 b.The guides 372 a, 372 b can slidably couple the top portion 352 to thebottom portion 350. In this regard, each guide 372 a, 372 b cancooperate with a respective one of the rails 360 a, 360 b to enable thetop portion 352 of the saddle 307 to move or translate relative to thebottom portion 350 of the saddle 307. Generally, each guide 372 a, 372 bcan comprise a dovetail shape.

It should be understood, however, that although the top portion 352 andthe bottom portion 350 are illustrated and described herein as includingrails and guides to enable the relative motion, any suitable device ormechanism could be used to enable the relative motion between the topportion 352 and the bottom portion 350, such as a monorail assembly,bearing, cam surface, etc. It should also be understood that the rails360 a, 360 b of the bottom portion 350 could be interchanged with theguides 372 a, 372 b of the top portion 352, if desired.

With reference to FIGS. 15-17 , in order to assemble the multiplanarbone anchor system 300, the ring 322 can be coupled to the shaft 308 bof the bone fastener 302. Then, the lock ring 304 can be positioned onthe head 308 of the bone fastener 302. Next, the first shell half 324and the second shell half 326 of the connecting arm 320 can be coupledto the ring 322 and the lock ring 304. The bottom portion 350 of thesaddle 307 can then be coupled to the connecting arm 320, such that theconnecting arm 320 can move or rotate relative to the bottom portion 350of the saddle 307. Next, the top portion 352 of the saddle 307 can becoupled to the bottom portion 350 so that the guides 372 a, 372 b aremovably or slidably coupled to the guides 372 a, 372 b of the connectingarm 320. Note that the movement of the top portion 352 relative to thebottom portion 350 can be limited by contact between the recess 374 a ofthe central bore 374 and the lock ring 304.

Once assembled, the connecting arm 320 can cooperate with the bonefastener 302 to enable movement or rotation of the bone fastener 302about the central or longitudinal axis of the bone fastener 302, whichprovides a first plane of motion. The bottom portion 350 of the saddle307 can also rotate relative to the bone fastener 302, and thus, the topportion 352 of the saddle 307 can rotate relative to the bone fastener302 to thereby define a second plane of motion. In addition, the topportion 352 can also move or translate relative to the bottom portion350, which can thereby define a third plane of motion. Therefore, whenassembled, the multiplanar bone anchor system 300 can have at leastthree degrees or planes of motion. By allowing the multiplanar boneanchor system 300 to move in at least three planes, the surgeon canmanipulate the multiplanar bone anchor system 300 as necessary toconform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system300 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 300 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 300 is secured to theanatomy, the multiplanar coupling system 306 and the saddle 307 can bemoved, rotated or translated relative to the bone fastener 302 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be coupled to a desired number of multiplanar boneanchor systems 300.

With reference now to FIGS. 18-20 , in one example, a multiplanar boneanchor system 400 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 400can be similar to the multiplanar bone anchor system 100, 300 describedwith reference to FIGS. 9-11 and 15-17 , only the differences betweenthe multiplanar bone anchor system 100, 300 and the multiplanar boneanchor system 400 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 400 can include the bonefastener 102, a lock ring 402, a multiplanar coupling arrangement orsystem 404 and a saddle 406.

The lock ring 402 can be positioned about the head 108 of the bonefastener 102. The lock ring 402 can couple or lock the bone fastener 102relative to the multiplanar coupling system 404 via a force applied bythe connecting rod 20, as will be discussed herein. As best shown inFIG. 20 , the lock ring 402 can be generally cylindrical, and can have aheight H4. The height H4 be sized to extend above or about equal to thereceiver surface 88 of the saddle 406 so that coupling the connectingrod 20 to the saddle 406 can compress the lock ring 402 onto the head108 of the bone fastener 102. In this example, with reference to FIG. 19, the lock ring 402 can include a cut out 402 a, which can facilitatepositioning the lock ring 402 about the head 108 of the bone fastener102. It should be understood, however, that the cut out 402 a can beoptional, as the lock ring 402 can have a continuous, uninterruptedcylindrical body. In addition, the lock ring 402 can include a proximalend 408, a distal end 410, a flange 412 and a bore 414.

The proximal end 408 can extend above or at the receiver surface 88 ofthe saddle 406 when the multiplanar bone anchor system 400 is assembled.The proximal end 408 can contact at least a portion of the connectingrod 20 when the connecting rod 20 is coupled to the multiplanar boneanchor system 400. The distal end 410 can be coupled to the head 108 ofthe bone fastener 102 when the lock ring 402 is coupled to bone fastener102. The flange 412 can be formed near or at the distal end 410, and canextend outwardly about an exterior circumference of the lock ring 402.The flange 412 can cooperate with a portion of the multiplanar couplingsystem 404 to couple or retain the lock ring 402 within the multiplanarcoupling system 404.

The bore 414 can be disposed about a central axis of the lock ring 402.The bore 414 can extend from the proximal end 408 to the distal end 410.The bore 414 can include a first countersink 414 a formed near or at theproximal end 408 and a second countersink 414 b formed near or at thedistal end 410. The first countersink 414 a can be configured to atleast partially receive a portion of the connecting rod 20 when theconnecting rod 20 is coupled to the multiplanar bone anchor system 400.The second countersink 414 b can comprise a bearing surface, which canbe slidably coupled to the head 108 of the bone fastener 102. Generally,the second countersink 414 b can enable the head 108 to move, rotateand/or pivot relative to the lock ring 402.

The multiplanar coupling system 404 can include a connecting arm 420.The connecting arm 420 can cooperate with the bone fastener 102 toenable the bone fastener 102 to move relative to the saddle 406. Itshould be noted that although the multiplanar coupling system 404 isdescribed and illustrated herein as including only a connecting arm 420,the multiplanar coupling system 404 could include a ring, if desired. Inthis example, the connecting arm 420 can have a cylindrical body, whichcan include a cut out 420 a. The cut out 420 a can facilitate thecoupling of the connecting arm 420 to the head 108 of the bone fastener302. For example, the cut out 420 a can enable the connecting arm 420 tobe snap-fit around the head 108 of the bone fastener 102. It should benoted, however, that the cut out 410 a can be optional, as theconnecting arm 420 could have a continuous, uninterrupted cylindricalbody. In the case of a continuous, uninterrupted cylindrical body, theconnecting arm 420 could be threaded over the shank 32 of the bonefastener 102 into engagement with the head 108 of the bone fastener 102.

In this example, the connecting arm 420 can further comprise a first orproximal end 422, a second or distal end 424, a channel 426, a bore 428and a coupling feature 430. The proximal end 422 can have a generallysmooth surface, which can be positioned adjacent to a portion of thesaddle 406 when the multiplanar bone anchor system 400 is assembled. Thedistal end 424 can be positioned opposite the proximal end 422, andgenerally, the distal end 424 can comprise a taper 424 a. The taper 424a can provide the connecting arm 420 with atraumatic edges.

The channel 426 can be defined between the proximal end 422 and thedistal end 424. The channel 426 can extend about an exteriorcircumference of the cylindrical body of the connecting arm 420. Thechannel 426 can receive a portion of the saddle 406 to couple theconnecting arm 420 to the saddle 406, as will be discussed in detailfurther herein.

The bore 428 can be defined about a central axis of the connecting arm420. The bore 428 can receive at least a portion of the lock ring 402and at least a portion of the bone fastener 102 therein to couple eachof the lock ring 402 and the bone fastener 102 to the connecting arm420. In this regard, with reference to FIG. 20 , the bore 428 caninclude a lock ring coupling portion 428 a and a bone fastener couplingportion 428 b. In one example, the lock ring coupling portion 428 a cancomprise a recess, which can be configured to engage the flange 412 ofthe lock ring 402. The engagement of the flange 412 of the lock ring 402with the lock ring coupling portion 428 a can couple or retain the lockring 402 within the connecting arm 420. The bone fastener couplingportion 428 b can comprise an annular or circumferential projection,which can extend about a circumference of the bore 428. Generally, thebone fastener coupling portion 428 b can be sized so as to engage thechannel 108 a formed in the head 108 of the bone fastener 102 so thatthe bone fastener 102 can move or rotate relative to the connecting arm420. Thus, the bone fastener coupling portion 428 b can comprise abearing surface, which can enable the bone fastener 102 to move orrotate relative to the connecting arm 420.

The coupling feature 430 can be formed adjacent to the cut out 420 a,and generally, can be formed to engage the channel 108 a of the bonefastener 102. The engagement of the coupling feature 430 with thechannel 108 a can enable the multiplanar coupling system 404 to move(rotate and pivot) relative to the bone fastener 102. It should benoted, however, that the coupling feature 430 can be optional, as anysuitable device or technique could be used to allow the multiplanarcoupling system 404 to move (rotate and pivot) relative to the bonefastener 102, such as a ring with wings, as discussed previously herein.

The saddle 406 can be coupled to the multiplanar coupling system 404 viathe connecting arm 420. Generally, the saddle 406 can be coupled to theconnecting arm 420 so that the connecting arm 420 can move or rotaterelative to the saddle 406, and so that the saddle 406 can move ortranslate relative to the multiplanar coupling system 404 and the bonefastener 102.

The saddle 406 can be substantially U-shaped and symmetrical withrespect to a longitudinal axis L defined by the multiplanar bone anchorsystem 400 (FIG. 20 ). The saddle 406 can include a first portion orbottom portion 460, the second portion or top portion 352 and a thirdportion or middle portion 462. The top portion 352 can move or translaterelative to the middle portion 462.

With reference to FIG. 19 , the bottom portion 460 of the saddle 406 canbe substantially similar to the bottom portion 350 of the saddle 307described with reference to FIGS. 15-17 , and thus, only the differencesbetween the bottom portion 460 of the saddle 406 and the bottom portion350 of the saddle 307 will be discussed in great detail herein. In thisregard, the bottom portion 460 of the saddle 406 can have asubstantially different geometric shape than the bottom portion 350 ofthe saddle 307. For example, the bottom portion 460 can be generallyoctagonal, such that the rails 360 a, 360 b associated with the first orproximal end 354 of the bottom portion 460 can be generally rectangularor dovetail in shape. By having a generally rectangular or dovetailshape, the rails 360 a, 360 b of the bottom portion 460 can have asubstantially larger length than the rails 360 a, 360 b of the bottomportion 350. This can enable the saddle 406 to move or translate for agreater distance than the saddle 307. It should be understood, however,that the bottom portion 460 can have the same shape as the bottomportion 350, if desired. The bottom portion 460 of the saddle 406 can becoupled to the connecting arm 420 so that the connecting arm 420 canmove or rotate relative to the saddle 406.

In this regard, the channel 426 of the connecting arm 420 can be coupledto the annular lip 356 a of the bottom portion 460 such that the annularlip 356 a rests in the channel 426 to retain the connecting arm 420 tothe bottom portion 460 of the saddle 406. The engagement between thechannel 426 and the annular lip 346 a can allow the connecting arm 420to move or rotate with the bone fastener 102, relative to at least thetop portion 352 of the saddle 406, as will be discussed further herein.

With reference to FIG. 20 , the bottom portion 460 can also include abore 358, which can be sized to enable at least a portion of the lockring 402 to pass through the bore 348. In addition, as discussed, thebore 348 can be configured to receive a portion of the connecting arm420 therein, when the connecting arm 420 is coupled to the bottomportion 460.

With continued reference to FIG. 20 , the top portion 352 of the saddle307 can be coupled to the middle portion 462 so that the top portion 352can move relative to at least one of the bottom portion 460 and themiddle portion 462, as will be discussed in greater detail herein. Themiddle portion 462 can be coupled between the top portion 352 and thebottom portion 460. Generally, the middle portion 462 can be movable ortranslatable relative to each of the top portion 352 and the bottomportion 460. The middle portion 462 can be generally octagonal in shape.It should be noted that the shape of the middle portion 462 is merelyexemplary, as any suitable shape could be used, such as cylindrical,rectangular, etc. The middle portion 462 can include a first or railsurface 464 opposite a second or guide surface 466 and a bore 468. Thebore 468 can be defined about a central axis of the middle portion 462,and can coaxially aligned with the bore 358 of the bottom portion 460and the central bore 374 of the top portion 352. The bore 468 can besized to enable a portion of the lock ring 402 to extend through themiddle portion 462.

The rail surface 464 can include at least one rail 464 a. Generally, therail surface 464 can include two rails 464 a, 464 b, which can beconfigured to movably or slidably engage the guides 372 a, 372 b of thetop portion 352. The engagement between the rails 464 a, 464 b and theguides 372 a, 372 b can enable the top portion 352 of the saddle 406 tomove or translate relative to the middle portion 462 of the saddle 406.

The guide surface 466 can include at least one guide 466 a. Generally,the guide surface 466 can include two guides 466 a, 466 b, which can beconfigured to movably or slidably engage the rails 360 a, 360 b of thebottom portion 460 of the saddle 406. The engagement between the guides466 a, 466 b and the rails 360 a, 360 b can enable the bottom portion460 of the saddle 406 to move or translate relative to the middleportion 462 of the saddle 406.

It should be understood, however, that although the top portion 352, themiddle portion 462 and the bottom portion 460 are illustrated anddescribed herein as including rails and guides to enable the relativemotion, any suitable device or mechanism could be used to enable therelative motion between the top portion 352, the middle portion 462 andthe bottom portion 460, such as a monorail assembly, etc. It should alsobe understood that the guides 372 a, 372 b, 466 a, 466 b of the topportion 352 and the middle portion 462 could be interchanged with therails 360 a, 360 b, 464 a, 464 b of the bottom portion 350 and themiddle portion 462, if desired.

With reference to FIGS. 19 and 20 , in order to assemble the multiplanarbone anchor system 400, the connecting arm 420 can be coupled to thechannel 108 a of the bone fastener 102. Then, the lock ring 402 can becoupled to the connecting arm 420. Next, the bottom portion 460 of thesaddle 406 can be coupled to the connecting arm 420, such that theconnecting arm 420 can move or rotate relative to the bottom portion 460of the saddle 406. The middle portion 462 can be coupled to the rails360 a, 360 b of the bottom portion 460 of the saddle 406 to enable themiddle portion 462 to move or translate relative to the bottom portion460. Note that the movement of the middle portion 462 relative to thebottom portion 460 can be limited by contact between a sidewall 468 a ofthe bore 468 of the middle portion 462 and the lock ring 402 (FIG. 20 ).Then, the top portion 352 of the saddle 406 can be coupled to the middleportion 462 so that the guides 372 a, 372 b are slidably coupled to therails 464 a, 464 b of the connecting arm 420. Note that the movement ofthe top portion 352 relative to the middle portion 462 can be limited bycontact between a sidewall 374 b of the bore 374 of the top portion 352and the lock ring 402 (FIG. 20 ).

Once assembled, the connecting arm 420 can cooperate with the bonefastener 102 to enable movement or rotation of the bone fastener 102about the central or longitudinal axis of the bone fastener 102, whichprovides a first plane of motion. The bottom portion 460 of the saddle406 can also rotate relative to the bone fastener 102, and thus, the topportion 352 of the saddle 406 can rotate relative to the bone fastener102 to thereby define a second plane of motion. In addition, the middleportion 462 can move or translate relative to the connecting arm 420,thereby defining a third plane of motion. As the top portion 352 canalso move or translate relative to the middle portion 462, themultiplanar bone anchor system 400 can define a fourth plane of motion.Therefore, when assembled, the multiplanar bone anchor system 400 canhave at least four degrees or planes of motion. By allowing themultiplanar bone anchor system 400 to move in at least four planes, thesurgeon can manipulate the multiplanar bone anchor system 400 asnecessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system400 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 300 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 400 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 400 is secured to theanatomy, the multiplanar coupling system 404 and the saddle 406 can bemoved, rotated or translated relative to the bone fastener 102 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be coupled to a desired number of multiplanar boneanchor systems 400.

With reference now to FIGS. 21-23 , in one example, a multiplanar boneanchor system 500 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 500can be similar to the multiplanar bone anchor system 100, 200 describedwith reference to FIGS. 9-15 , only the differences between themultiplanar bone anchor system 100, 200 and the multiplanar bone anchorsystem 500 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 500 can include the bonefastener 102, a lock ring 502, a multiplanar coupling arrangement orsystem 504 and a saddle 506. It should be noted that although themultiplanar bone anchor system 500 is described and illustrated hereinas including the lock ring 502, it should be understood that themultiplanar bone anchor system 500 need not include the lock ring 502.Furthermore, the multiplanar bone anchor system 500 could employ thelock ring 14 instead of the lock ring 502, if desired.

The lock ring 502 can be received within the saddle 506, and cancooperate the multiplanar coupling system 504 and the saddle 506 tofixedly couple or lock the bone fastener 102 into a desired angularposition (FIG. 23 ). In one example, with reference to FIG. 22 , thelock ring 502 can include a continuous cylindrical body, which can beformed out of any suitable biocompatible material, such as abiocompatible metal, ceramic, metal alloy, polymer or combinationsthereof. The lock ring 502 can include a first or proximal end 507, asecond or distal end 508 and a flange 509. In addition, the lock ring502 can include a bore 502 a, which can enable a tool to engage thedriver interface feature 34 of the bone fastener 102.

The proximal end 507 of the lock ring 502 can define a first concavesurface 507 a, which can have a curvature configured to mate with theconnecting rod 20. In this regard, the lock ring 502 can support aportion of the connecting rod 20 when the connecting rod 20 is coupledto the multiplanar bone anchor system 500. In this example, the forceapplied by the set screw 22 to couple the connecting rod 20 to themultiplanar bone anchor system 500 can apply a force to the lock ring502 to fixedly couple or lock the bone fastener 102 in the desiredangular position.

The distal end 508 of the lock ring 502 can apply a force to the head108 of the bone fastener 102 to fixedly couple or lock the bone fastener102 in the desired angular position. With reference to FIG. 23 , thedistal end 508 can define a second concave surface 508 a. The concavesurface 508 a can be configured to mate with the head 108 of the bonefastener 102 to fixedly couple or lock the bone fastener 102 in thedesired angular position when the force is applied to the lock ring 502.

The flange 509 can extend about a circumference of the lock ring 502,and can be positioned between the proximal end 507 and the distal end508 of the lock ring 502. The flange 509 can be integrally formed withthe lock ring 502, or could be coupled to the circumference of the lockring 502 through any suitable manufacturing technique, such asovermolding, adhesives, etc. The flange 509 can be configured to engagea portion of the multiplanar coupling system 504 to couple the lock ring502 to the multiplanar coupling system 504, as will be discussed ingreater detail herein.

With reference to FIGS. 21-23 , the multiplanar coupling system 504 caninclude a connecting arm 510, at least one plug 538 and a retaining clip514. In one example, the multiplanar coupling system 504 can include twoplugs 538. The connecting arm 510 and the plugs 538 can cooperate withthe bone fastener 102 to enable the bone fastener 102 to move relativeto the saddle 506. The connecting arm 510 can be disposed about a head30 of the bone fastener 102 to enable the bone fastener 102 to move orarticulate relative to the saddle 506. In this example, the connectingarm 510 can be cylindrical, and can be coupled to the saddle 506 via theretaining clip 514, as will be discussed (FIG. 23 ). The connecting arm510 can include a first or proximal end 520, a channel 522, a second ordistal end 524 and a bore 526.

The proximal end 520 can be received within the saddle 506, when thesaddle 506 is coupled to the connecting arm 510 (FIG. 23 ). The channel522 can be disposed between the proximal end 520 and the distal end 524.The channel 522 can be received within the saddle 506 and can cooperatewith the saddle 506 and the retaining clip 514 to couple the connectingarm 510 to the saddle 506, as will be discussed. A majority of thedistal end 524 can be disposed outside of the saddle 506 when theconnecting arm 510 is coupled to the saddle 506 (FIG. 23 ). The distalend 524 can include at least one flange 528.

In one example, with continued reference to FIG. 23 , the distal end 524can include two flanges 528 a, 528 b. Generally, the flanges 528 can bepositioned opposite each other, and can each extend for a length beyondthe distal end 524 of the connecting arm 510, as shown in FIG. 22 . Withreference back to FIG. 23 , each of the flanges 528 can include a bore530. Each of the bores 530 can receive a portion of one of the plugs 538to couple the bone fastener 102 to the connecting arm 510, as will bediscussed in greater detail herein. In one example, the bores 530 can bedefined through the circumference of the flanges 528 such that the bores530 are in communication with the bore 526.

The bore 526 can be defined from the proximal end 520 to the distal end524. The bore 526 can be formed about a central axis of the connectingarm 510. The bore 526 can receive at least a portion of the lock ring502 when the multiplanar bone anchor system 500 is assembled. In thisregard, with reference to FIG. 23 , the bore 526 can include a lock ringcoupling portion 526 a, a bearing portion 526 b and a limiting portion526 c.

The lock ring coupling portion 526 a can be formed near or at theproximal end 520. The lock ring coupling portion 526 a can be configuredto engage the flange 509 of the lock ring 502 to couple the lock ring502 to the connecting arm 510. In one example, the lock ring couplingportion 526 a can comprise a portion of the bore 526 that has a contourthat mates with an exterior contour of the lock ring 502, however, itshould be understood that the lock ring coupling portion 526 a can haveany desired configuration operable to retain the lock ring 502 withinthe connecting arm 510. In this example, the lock ring coupling portion526 a can be formed such that the proximal end 507 of the lock ring 502extends beyond the proximal end 520 of the connecting arm 510 so thatthe connecting rod 20 can be received within the concave surface 507 aof the lock ring 502.

The bearing portion 526 b can be formed adjacent to the proximal end 520of the connecting arm 510. The bearing portion 526 b can be generallyconcave, and can be configured to mate with at least a portion of thehemispherical head 30 of the bone fastener 102. The bearing portion 526b can enable the bone fastener 102 to move, rotate or articulaterelative to the connecting arm 510. The limiting portion 526 c can bedefined adjacent to the distal end 524 of the connecting arm 510.Although not illustrated herein, the limiting portion 526 c can includea taper, if desired. Generally, the limiting portion 526 c can limit therange of motion or articulation of the bone fastener 102.

With reference to FIG. 22 , the plugs 538 can cooperate with theconnecting arm 510 to enable the bone fastener 102 to move or rotateabout the longitudinal axis L2 of the bone fastener 102. The plugs 538can couple the bone fastener 102 to the connecting arm 510. Each of theplugs 538 can include a coupling end 540. The coupling end 540 cancouple the plug 538 to the connecting arm 510. The coupling end 540 caninclude a fastening feature 540 a, which can be accessible when theplugs 538 are coupled to the connecting arm 510. The fastening feature540 a can comprise any suitable feature, such as a slot, cut-out orother feature engagable by a tool. Generally, the fastening feature 540a can enable a tool, such as a driver, to couple the plug 538 to theconnecting arm 510 and the head 30 of the bone fastener 12. In addition,if desired, the plugs 538 could be integrally formed with the connectingarm 510. It should be noted that the shape of the plugs 538 is merelyexemplary, as the plugs 538 could have any desired shape, such aselliptical, spherical, rounded, annular, cylindrical, rounded square,rounded rectangular, etc. In addition, although not illustrated herein,the plugs 538 can include one or more tapered surfaces, which can enablethe bone fastener 102 to move or pivot relative to the connecting arm510, if desired.

With reference to FIGS. 22 and 23 , the retaining clip 514 can couplethe saddle 506 to the connecting arm 510. The retaining clip 514 cancomprise a substantially U-shaped clip, such as Dutchman clip, forexample. As a Dutchman clip can be generally known, the retaining clip514 will not be discussed in great detail herein. Briefly, however, theretaining clip 514 can define a first arm 514 a and a second arm 514 b,which can be coupled together via a connector 514 c. Each of the firstarm 514 a and the second arm 514 b can include a locking tang T.Generally, the first arm 514 a and the second arm 514 b can be flexible,so that the retaining clip 514 can be biased into engagement with thesaddle 506 and the connecting arm 510. As will be discussed, theretaining clip 514 can be received through a portion of the saddle 506and through the channel 522 of the connecting arm 510 to movably orrotatably couple the saddle 506 to the connecting arm 510.

The saddle 506 can include the first or proximal end 76 and a second ordistal end 550. The distal end 550 can be generally cylindrical, and caninclude the first or a receiver surface 88, a second or bottom surface552, a central bore 554 and at least one slot 556.

As best shown in FIG. 23 , the bottom surface 552 can include a taper552 a. The taper 552 a can provide the bottom surface 552 withatraumatic edges. The central bore 554 can be defined from the receiversurface 88 through to the bottom surface 552 of the saddle 506. Thecentral bore 554 can be configured to receive at least a portion of theconnecting arm 510 rotatably therein. Thus, the central bore 554 canhave a diameter, which can be slightly greater than a diameter of theconnecting arm 510, so that the connecting arm 510 can rotate relativeto the saddle 506.

The at least one slot 556 can be defined through a portion of the distalend 550 of the saddle 506. In one example, the at least one slot 556 cancomprised two slots 556. The two slots 556 can be formed opposite eachother, and can generally be formed a distance apart, with the distancebetween the two slots 556 about equal to a length of the connector 514 cof the retaining clip 514.

The slots 556 can be defined from a first side 550 a to a second side550 b of the distal end 550 of the saddle 506. The slots 556 can have alength from the first side 550 a to the second side 550 b, which can beabout equal to a length of the first arm 514 a and the second arm 514 b.Given the length of the slots 556, the connector 514 c of the retainingclip 514 can generally be disposed adjacent to an exterior surface ofthe distal end 550 of the saddle 506 (FIG. 23 ). It should be noted,however, that the saddle 506 could be configured so that the connector514 c is received within the saddle 506 when the retaining clip 514 iscoupled to the saddle 506 and connecting arm 510.

The slots 556 can each include a tab 556 a, which can be formed near thesecond side 550 b of the distal end 550. The tab 556 a can cooperatewith the tang T of the first arm 514 a and the second arm 514 b tocouple the retaining clip 514 to the saddle 506. By coupling theretaining clip 514 to the saddle 506, the connecting arm 510 can also becoupled to the saddle 506.

In this regard, with reference to FIGS. 22 and 23 , in order to assemblethe multiplanar bone anchor system 500, the lock ring 502 can bepositioned within the bore 526 and coupled to the lock ring couplingportion 526 a via the flange 509 of the lock ring 502. With the lockring 502 coupled to the connecting arm 510, the distal end 550 of thesaddle 506 can be positioned onto the proximal end 520 of the connectingarm 510. Next, the bone fastener 102 can be coupled to the connectingarm 510 by snap-fitting, press-fitting or threading the plugs 538 intoengagement with the bores 530 of the connecting arm 510 so that the bonefastener 102 can move (rotate and pivot) relative to the connecting arm510.

With the distal end 550 of the saddle 506 positioned about at least theproximal end 520 of the connecting arm 510, the retaining clip 514 canbe inserted into the slots 556 so that the tangs T of the first arm 514a and the second arm 514 b can engage the tabs 556 a of the slots 556.The first arm 514 a and the second arm 514 b can be inserted such thatthe first arm 514 a and the second arm 514 b can be at least partiallyretained within the channel 522 of the connecting arm 510. Thus, theretaining clip 514 can be employed to couple the connecting arm 510 andbone fastener 102 to the saddle 506.

Once assembled, the plugs 538 can cooperate with the channel 108 a ofthe bone fastener 102 to enable movement or rotation of the bonefastener 102 about the central or longitudinal axis of the bone fastener102, thereby providing a first plane of motion. In addition, theretaining clip 514 can enable the connecting arm 510 to move or rotaterelative to the saddle 506, thereby defining a second plane of motion.Thus, when assembled, the multiplanar bone anchor system 500 can have atleast two planes or degrees of motion. By allowing the multiplanar boneanchor system 500 to move in at least two planes, the surgeon canmanipulate the multiplanar bone anchor system 500 as necessary toconform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system500 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 100, 200 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 500 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 500 is secured to theanatomy, the bone fastener 102, the multiplanar coupling system 504and/or the saddle 506 can be moved or rotated relative to one anotheruntil the multiplanar bone anchor system 500 is in the desired alignmentfor the fixation procedure. Once the aligned, the connecting rod 20 canbe coupled to a desired number of multiplanar bone anchor systems 500.

With reference now to FIGS. 24-26 , in one example, a multiplanar boneanchor system 600 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 600can be similar to the multiplanar bone anchor system 400 described withreference to FIGS. 18-20 , only the differences between the multiplanarbone anchor system 400 and the multiplanar bone anchor system 600 willbe discussed in great detail herein, and the same reference numeralswill be used to denote the same or similar components. The multiplanarbone anchor system 600 can include the bone fastener 102, a lock ring602, a multiplanar coupling arrangement or system 604 and a saddle 606.

The lock ring 602 can be positioned about the head 108 of the bonefastener 102. The lock ring 602 can couple or lock the bone fastener 102relative to the multiplanar coupling system 604 via a force applied bythe connecting rod 20, as will be discussed herein. With reference toFIG. 26 , the lock ring 602 can be generally cylindrical, and can have aheight H6. The height H6 be sized to extend above or about equal to areceiver surface 88 of the saddle 606 so that coupling the connectingrod 20 to the saddle 606 can compress the lock ring 602 onto the head108 of the bone fastener 102. In this example, the lock ring 602 caninclude a cut out 602 a, which can facilitate positioning the lock ring602 about the head 108 of the bone fastener 102. It should beunderstood, however, that the cut out 602 a can be optional, as the lockring 602 can have a continuous, uninterrupted cylindrical body. Inaddition, the lock ring 602 can include the proximal end 408, a distalend 610, the flange 412 and the bore 414. With reference to FIGS. 25 and26 , the distal end 610 can be coupled to the head 108 of the bonefastener 102 when the lock ring 602 is coupled to bone fastener 102.

The multiplanar coupling system 604 can include a connecting arm 620.The connecting arm 620 can cooperate with the bone fastener 102 toenable the bone fastener 102 to move relative to the saddle 606. Itshould be noted that although the multiplanar coupling system 604 isdescribed and illustrated herein as including only a connecting arm 620,the multiplanar coupling system 604 could include a ring, such as thering 322 illustrated in FIG. 16 , if desired. In this example, theconnecting arm 620 can have a cylindrical body, which can include a cutout 620 a. The cut out 620 a can facilitate the coupling of theconnecting arm 620 to the head 108 of the bone fastener 102. Forexample, the cut out 620 a can enable the connecting arm 620 to besnap-fit around the head 108 of the bone fastener 102. It should benoted, however, that the cut out 620 a can be optional, as theconnecting arm 620 could have a continuous, uninterrupted cylindricalbody. In the case of a continuous, uninterrupted cylindrical body, theconnecting arm 620 could be threaded over the shank 32 of the bonefastener 102 into engagement with the head 108 of the bone fastener 102.

In this example, the connecting arm 620 can further comprise a first orproximal end 622, the second or distal end 424, the channel 426, thebore 428 and the coupling feature 430. The proximal end 622 can includea plurality of arcuate members 622 a, which can each be separated by oneor more spaces 622 b. The plurality of arcuate members 622 a cangenerally be formed about a circumference of the proximal end 622. Theplurality of arcuate members 622 a can cooperate with the channel 426 tocouple the connecting arm 620 to the saddle 606. The one or more spaces622 b can enable the plurality of arcuate members 622 a to be flexible,such that the plurality of arcuate members 622 a can be snap-fit intoengagement with the saddle 606.

Generally, with reference to FIGS. 25 and 26 , the saddle 606 can becoupled to the connecting arm 620 so that the connecting arm 620 canmove or rotate relative to the saddle 606. The saddle 606 can besubstantially U-shaped and symmetrical with respect to a longitudinalaxis L2 defined by the multiplanar bone anchor system 600. The saddle606 can include the first or proximal end 76 and a second or distal end640.

With reference to FIG. 25 , the distal end 640 of the saddle 606 can begenerally rectangular, and can include the first or a receiver surface88, a second or bottom surface 644 and a bore 646. With reference toFIG. 26 , the bottom surface 644 can include a lip 644 a. The lip 644 acan extend downwardly from the bottom surface 644 about the perimeter ofthe bottom surface 644. The lip 644 a can be configured to be receivedin the channel 426 so that a portion of the bore 646 can surround theplurality of arcuate members 622 a to couple the saddle 606 to theconnecting arm 620. This can also enable the saddle 606 to move orrotate relative to the connecting arm 620.

With reference to FIGS. 25 and 26 , in order to assemble the multiplanarbone anchor system 600, the connecting arm 620 can be coupled to thechannel 108 a of the bone fastener 102. Then, the lock ring 602 can becoupled to the connecting arm 620. Next, the distal end 640 of thesaddle 606 can be coupled to the connecting arm 620, such that theconnecting arm 620 can move or rotate relative to the saddle 606.

Once assembled, the connecting arm 620 can cooperate with the bonefastener 102 to enable movement or rotation of the bone fastener 102about the central or longitudinal axis of the bone fastener 102, whichcan provide a first plane of motion. The saddle 606 can also rotaterelative to the connecting arm 620, which can thereby define a secondplane of motion. In addition, the saddle 606 can rotate relative to thebone fastener 102 to thereby define a third plane of motion. Therefore,when assembled, the multiplanar bone anchor system 600 can have at leastthree degrees or planes of motion. By allowing the multiplanar boneanchor system 600 to move in at least three planes, the surgeon canmanipulate the multiplanar bone anchor system 600 as necessary toconform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system600 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 400 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 600 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 600 is secured to theanatomy, the multiplanar coupling system 604 and the saddle 606 can bemoved or rotated relative to the bone fastener 102 into the desiredalignment for the fixation procedure. Once the aligned, the connectingrod 20 can be coupled to a desired number of multiplanar bone anchorsystems 600.

With reference to FIG. 27 , while the multiplanar bone anchor system 300has been described herein with reference to FIGS. 15-17 as including thebone fastener 302, the lock ring 304, the connecting arm 320, the ring322 and the bottom portion 350, those of skill in the art willappreciate that the present disclosure, in its broadest aspects, may beconstructed somewhat differently. In this regard, a multiplanar boneanchor system 300′ could include the bone fastener 102, the lock ring402, the connecting arm 420 and the bottom portion 460 associated withthe multiplanar bone anchor system 400. In this example, the multiplanarbone anchor system 300′ can provide multiple planes of motion whilerequiring fewer components, which may be desirable for manufacturingpurposes.

As a further example, with reference to FIGS. 28-30 , while themultiplanar bone anchor system 10, 100, 200, 500 has been describedherein as having a ring 50, 112, 322, those of skill in the art willappreciate that the present disclosure, in its broadest aspects, may beconstructed somewhat differently. In this regard, a connecting arm 700could be employed in place of the ring 50, 112, 322. The connecting arm700 can cooperate with the bone fastener 102, and can include at leastone bore 702 and at least one plug 704. The connecting arm 700 can alsodefine a throughbore 706, which can receive the head 108 of the bonefastener 102 therein. The at least one plug 704 can be coupled to the atleast one bore 702 of the connecting arm 700 to enable the bone fastener102 to rotate relative to the connecting arm 700. In this example, theat least one plug 704 can include two plugs 704, which can be receivedwithin two opposite bores 702. Each of the plugs 704 can be press fitinto the bores 702 so that a bearing surface 704 a formed on the plugs704 can rotate about the channel 108 a of the bone fastener 102.

With reference now to FIGS. 31-36 , in one example, a multiplanar boneanchor system 800 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 800can be similar to the multiplanar bone anchor system 10 described withreference to FIGS. 1-8 , only the differences between the multiplanarbone anchor system 10 and the multiplanar bone anchor system 800 will bediscussed in great detail herein, and the same reference numerals willbe used to denote the same or similar components. The multiplanar boneanchor system 800 can include a bone fastener 802, a multiplanarcoupling arrangement or system 804 (FIG. 33 ) and a saddle 806 (FIG. 31). The multiplanar bone anchor system 800 can define a longitudinal axisL, and the multiplanar bone anchor system 800 can be configured suchthat the bone fastener 802 and the saddle 806 can move relative to thelongitudinal axis L in multiple planes.

As will be discussed in greater detail herein, the multiplanar couplingsystem 804 can enable the saddle 806 to move relative to the bonefastener 802 in multiple planes. Generally, the saddle 806 can beconfigured to receive the connecting device or rod 20, which can be usedto interconnect multiple bone anchor systems 800 in an exemplary spinalfixation procedure (similar to that illustrated in FIG. 1 ). By usingthe multiplanar coupling system 804, the saddle 806 can be movedrelative to the bone fastener 802 in one or more planes to facilitatethe connection of the connecting rod 20 to multiple bone anchor systems800. In this regard, the vertebral bodies V of the patient may beorientated in such a manner that each bone fastener 802, when coupled toa respective vertebral body V, may be slightly offset from one another.By allowing the saddle 806 to move in multiple planes relative to thebone fastener 802, the surgeon can move the saddles 806 into alignmentwithout regard to the placement of the bone fasteners 802. It should benoted, however, that although the multiplanar bone anchor system 800 isgenerally illustrated and described herein a single assembly for usewith a single connecting rod 20, any combination of bone anchor systems800 and connecting rods 20 can be employed during a surgical procedure.

For example, in a single level spinal fixation procedure, two boneanchor systems 800 can receive a single connecting rod 20. A multiplelevel spinal fixation procedure, however, will generally requireadditional bone anchor systems 800. In addition, the multiplanar boneanchor systems 800 need not be coupled to adjacent vertebral bodies V,but rather, the multiplanar bone anchor systems 800 can be positioned soas to skip adjacent vertebral bodies V, if desired.

With reference to FIG. 33 , the bone fastener 802 can be configured toengage the anatomy to couple the multiplanar bone anchor system 800 tothe anatomy. The bone fastener 802 can be composed of any suitablebiocompatible material, such as titanium, stainless steel, biocompatiblemetals, metal alloys, polymers, etc. The bone fastener 802 can include aproximal end or head 810 and the distal end or shank 32. The head 810can include a first or upper portion 812 and a second or lower portion814.

The upper portion 812 can include a contact surface 815 and the driverconnection feature 34. The contact surface 815 can be adjacent to theconnecting rod 20 when the connecting rod 20 is received within thesaddle 806. As will be discussed greater herein, in one example, whenthe set screw 22 is coupled to the saddle 806 to lock the connecting rod20 to the multiplanar bone anchor system 800, the connecting rod 20 canbe pushed or forced into engagement with the contact surface 815. Thecontact between the contact surface 815 and the connecting rod 20 canfrictionally lock the bone fastener 802 relative to the saddle 806,thereby preventing further movement of the bone fastener 802. It shouldbe noted, however, that depending upon the angulation of the bonefastener 802, the lower portion 814 could also be in contact with theconnecting rod 20.

In one example, the contact surface 815 can be formed on the driverconnection feature 34, and can comprise, for example, a roughened orknurled surface formed along a proximalmost surface 812 a of the driverconnection feature 34. It should be noted that the contact surface 815is merely exemplary, and the upper portion 812 could comprise a smoothsurface, if desired.

Briefly, it should be noted that particular tools or use with themultiplanar bone anchor system 10 are beyond the scope of the presentteachings and need not be described herein. In a conventional mannerinsofar as the present teachings are concerned, various tools can beused to connect the multiplanar bone anchor system 10 to a respectivevertebral body V. Exemplary tools can include those employed in thePolaris™ 5.5 Spinal System, commercially available from Biomet, Inc. ofWarsaw, Ind., or the tools disclosed in commonly owned U.S. PatentPublication No. 2008/0077138, filed on Apr. 20, 2007 and incorporated byreference herein.

The lower portion 814 of the head 810 can be generally hemispherical orconical. The lower portion 814 can provide a bearing surface 814 a,which can cooperate with the multiplanar coupling system 804 to enablethe movement (rotation, articulation) of the bone fastener 802 withinthe saddle 806, as will be discussed in greater detail herein.Generally, the bone fastener 802 can rotate about the longitudinal axisL and can also pivot in a single plane or multiple planes relative tothe longitudinal axis L, as will be discussed herein. In addition, aproximalmost surface of the lower portion 814 can cooperate with aportion of the multiplanar coupling system 804 to provide a frictionalfit between the bone fastener 802 and the multiplanar coupling system804.

In one example, the multiplanar coupling system 804 can include aconnecting arm 816. The connecting arm 816 can be composed of anysuitable biocompatible material, such as a biocompatible metal, metalalloy, ceramic or polymer. The connecting arm 816 can be disposed aboutthe head 810 of the bone fastener 802 to allow relative movement betweenthe bone fastener 802 and the saddle 806, as shown in FIG. 32 . Theconnecting arm 816 can be sized to fit within the saddle 806, and canalso allow a portion of the saddle 806 to move or translate relative toanother portion of the saddle 806, as will be discussed in greaterdetail herein. With reference to FIGS. 33-35 , the connecting arm 816can include a first or upper portion 820, a second or lower portion 822and a bore 824.

The upper portion 820 can be shaped to be received within a portion ofthe saddle 806, and can be generally rectangular with rounded corners.In one example, the upper portion 820 can have opposite curved features821. The opposite curved features 821 can include a generally straightportion 821 a. As will be discussed in greater detail herein, thestraight portion 821 a can cooperate with the saddle 806 to enable thesaddle 806 to move or translate relative to the upper portion 820 of theconnecting arm 816. The opposite curved features 821 can projectoutwardly from or extend outwardly away from the lower portion 822 ofthe connecting arm 816 and can aid in retaining a portion of the saddle806 on the connecting arm 816, as will be discussed in greater detailherein. With reference to FIG. 34 , the upper portion 820 can include atleast one friction surface 826, a retention surface 828 and a rail 829.

The at least one friction surface 826 can be formed on opposite sides ofthe bore 824 along an exterior surface of the connecting arm 816. In oneexample, the at least one friction surface 826 can comprise a first leafspring 826 a and a second leaf spring 826 b. It should be noted thatalthough the at least one friction surface 826 is described andillustrated herein as comprising two leaf springs, the at least onefriction surface 826 could comprise a single leaf spring, a frictionalcoating or other interference, which can control the movement of aportion of the saddle 806 relative to the connecting arm 816 and anotherportion of the saddle 806, as will be discussed in greater detailherein.

The retention surface 828 can be formed on the upper portion 820 near anend 820 a of the upper portion 820. The retention surface 828 can extendslightly into the bore 824 so as to form a lip to retain the bonefastener 802 within the connecting arm 816. Generally, the retentionsurface 828 can extend about a majority of a circumference of the bore824, but the retention surface 828 could be formed about the entirecircumference of the bore 824 if desired. Further, it should be notedthat the use of a retention surface 828 is merely exemplary, as anysuitable feature could be used to retain the bone fastener 802 withinthe connecting arm 816 such as one or more protrusions extending intothe bore 824.

The rail 829 can be formed below each of the opposite curved features821, and can provide a contact surface for a portion of the saddle 806to move or translate relative to the connecting arm 816 (FIG. 36 ). Therail 829 can be positioned adjacent to the lower portion 822.

With reference to FIGS. 34 and 35 , the lower portion 822 can include aconnection surface 830 and a preferred angle slot 832. The connectionsurface 830 can comprise at least one flat surface 834 and at least onerib 836. The at least one flat surface 834 and at least one rib 836 cancooperate with a portion of the saddle 806 to couple that portion of thesaddle 806 immovably to the connecting arm 816. In one example, theconnecting surface 830 can comprise three flat surfaces 834 a-834 c andfour ribs 836 a-836 d. The flat surfaces 834 a-834 c can generallyalternate with the ribs 836 a-836 d about an exterior surface of thelower portion 822. The flat surfaces 834 a-834 d can prevent theconnecting arm 816 from rotating relative to the portion of the saddle806. The ribs 836 a-836 d can be formed along arcuate surfaces of thelower portion 822 and can be positioned a distance D from a bottommostsurface 822 a of the lower portion 822 (FIG. 35). The ribs 836 a-836 dcan create an overlap interference or snap fit between the portion ofthe saddle 806 and the lower portion 822, as will be discussed ingreater detail herein. It should be noted, however that the use the ribs836 a-836 d is merely exemplary, as any suitable mechanism could beemployed to couple the portion of the saddle 806 to the lower portion822, such as pins, threads, etc.

The preferred angle slot 832 can enable the bone fastener 802 toarticulate to a greater angle A relative to a longitudinal axis L of themultiplanar bone anchor system 800. In this regard, with reference toFIG. 36 , the bone fastener 802 can generally articulate to an angle A1relative to the longitudinal axis L along the portion of the connectingarm 816 that does not include the preferred angle slot 832. At thelocation of the preferred angle slot 832, the bone fastener 802 cangenerally articulate to the greater angle A relative to the longitudinalaxis L. In one example, the angle A1 can be generally about less thanthe greater angle A, and the greater angle A can be between about 15degrees and about 90 degrees. The preferred angle slot 832 can comprisean arcuate cut-out defined through the lower portion 822 of theconnecting arm 816, which can be in communication with the bore 824. Thearcuate cut-out of the preferred angle slot 832 can enable the bonefastener 802 to move or articulate to the greater angle A relative tothe longitudinal axis L.

It should be noted that although only one preferred angle slot 832 isillustrated in the drawings, the connecting arm 816 can include anynumber of preferred angle slots 832 at any location along the connectingarm 816 to enable the bone fastener 802 to articulate in any selecteddirection. It should also be noted that the shape of the cut-out thatforms the preferred angle slot 832 can be modified to reduce or increasethe greater angle A of the articulation of the bone fastener 802relative to the longitudinal axis L. Alternatively, the connecting arm816 could be devoid of a preferred angle slot, if desired.

With reference to FIGS. 33-36 , in one example, the bore 824 of theconnecting arm 816 can be formed along the longitudinal axis L and canextend through an interior surface of the connecting arm 816 from theupper portion 820 to the lower portion 822. The bore 824 can be sized toreceive the bone fastener 802, and can include a bearing surface 838.The bearing surface 838 can allow the bone fastener 802 to articulatewithin the connecting arm 816. The bearing surface 838 can be disposedabout a portion of the bore 824 of the connecting arm 816, and can havea curve configured to mate with the bearing surface 814 a of the bonefastener 802.

With reference to FIGS. 31-33 , the saddle 806 can be coupled to theconnecting arm 816 and can move or translate relative to the connectingarm 816. In this regard, the saddle 806 can include a first portion orbottom portion 840 and a second portion or top portion 842. The bottomportion 840 can be immovably coupled to the connecting arm 816, and thetop portion 842 can move or translate relative to the bottom portion 840and the connecting arm 816 (FIG. 32 ). It should be noted that thebottom portion 840 can be optional, if desired.

In one example, with reference to FIG. 33 , the bottom portion 840 caninclude opposed generally arcuate surfaces 840 a, which can beinterconnected by generally straight or flat surfaces 840 b. The shapeof the bottom portion 840 can cooperate with the shape of the connectingarm 816 so that the bottom portion 840 can be coupled to the connectingarm 816. The bottom portion 840 can include a first or proximal end 844,a second or distal end 846 and a bore 848.

The proximal end 844 can be positioned adjacent to the top portion 842when the saddle 806 is coupled to the connecting arm 816. The distal end846 can include a preferred angle slot 850. The preferred angle slot 850can be defined through the distal end 846 so as to be in communicationwith the bore 848. The preferred angle slot 850 of the bottom portion840 can be positioned in substantially the same location relative to theconnecting arm 816 such that when the bottom portion 840 is coupled tothe connecting arm 816, the preferred angle slot 850 of the bottomportion 840 is aligned with the preferred angle slot 832 of theconnecting arm 816. The alignment between the preferred angle slot 832and the preferred angle slat 850 can enable the bone fastener 802 tomove or articulate to the greater angle A (FIG. 36 ).

With reference to FIG. 36 , in one example, the bore 848 can be formedalong the longitudinal axis L from the proximal end 844 to the distalend 846. With reference to FIG. 33 , the bore 848 can be sized andconfigured to be immovably coupled about the connecting arm 816. Thebore 848 can include a rounded or chamfered edge 852, at least onegroove 854 and at least one flat surface 856. The chamfered edge 852 canbe formed at the proximal end 844. The chamfered edge 852 can provide alead-in for coupling the bottom portion 840 to the connecting arm 816.It should be noted that the chamfered edge 852 can be optional.

The at least one groove 854 and the at least one flat surface 856 of thebottom portion 840 can cooperate with the at least one flat surface 834and the at least one rib 836 of the connecting arm 816 to couple thebottom portion 840 to the connecting arm 816. In one example, the bore848 can include four grooves 854 a-854 d and three flat surfaces 856a-856 c. A respective one of each of the grooves 854 a-854 d can engagea respective one of each of the ribs 836 a-836 d. The grooves 854 a-854d can be positioned about the bore 848 so that the grooves 854 a-854 dalternate with the flat surfaces 856 a-856 c. The flat surfaces 856a-856 c can cooperate with the flat surfaces 834 a-834 c of theconnecting arm 816 to resist relative rotation between the connectingarm 816 and the bottom portion 840.

With reference to FIG. 36 , the top portion 842 of the saddle 806 can bedisposed about the curved features 821 of the connecting arm 816. Thetop portion 842 can move or translate relative the connecting arm 816,and thus, move or translate relative to the bottom portion 840. The topportion 842 can be substantially U-shaped and symmetrical with respectto a longitudinal axis L defined by the multiplanar bone anchor system800. The top portion 842 can include a first or proximal end 860 and asecond or distal end 862. In one example, with reference to FIG. 33 ,the proximal end 860 can include a first arm 864 and a second arm 866.The first arm 864 and second arm 866 can extend upwardly from the distalend 862 to define the U-shape. Each of the first arm 864 and the secondarm 866 can include the mating portion 84, a cavity 868 and a connectorfeature 870.

With reference to FIGS. 33 and 36 , the cavity 868 can be defined ineach interior surface 864 a, 866 a of the first arm 864 and the secondarm 866. The cavity 868 can provide clearance for the movement orarticulation of the top portion 842 relative to the bottom portion 840of the saddle 806. In this regard, the cavity 868 can be defined so asto allow the top portion 842 to move over the head 810 of the bonefastener 802, which can provide a range of motion for the top portion842 relative to the bottom portion 840. If desired, the cavity 868 couldbe configured such that contact between the head 810 of the bonefastener 802 and the cavity 868 can act as a stop to limit the movementor translation of the top portion 842 relative to the bottom portion840. Further, other techniques could be used to stop or limit themovement or translation of the top portion 842 relative to the bottomportion 840, such as features formed on the connecting arm 816.

With reference to FIG. 33 , the connector feature 870 can be defined inan exterior surface 864 b, 866 b of the first arm 864 and the second arm866. The connector feature 870 can enable the multiplanar bone anchorsystem 800 to be coupled to instrumentation, such as rod reductioninstruments or to a suitable cross-connector device in a spinal fixationprocedure. The connector feature 870 is illustrated herein as comprisinga triangular recess with rounded corners formed in each of the first arm864 and the second arm 866, however, it should be noted that theconnector feature 870 can have any selected shape and dimension tocooperate with a selected cross-connector device or instrument.

With reference to FIG. 33 , the distal end 862 of the top portion 842can be generally rectangular, and can include rounded corners tocorrespond with the shape of the bottom portion 840. It should be notedthat the shape of the bottom portion 840 does not have to be generallyrectangular, but could be generally square, cylindrical, oval, etc. Thedistal end 862 can include the first or receiver surface 88, a second orbottom surface 872, at least one bore 874 and a central bore 876.

With reference to FIG. 36 , the bottom surface 872 of the distal end 862can include at least one guide 878. In one example, the bottom surface872 of the distal end 862 can include two guides 878 a, 878 b, which canbe positioned opposite each other and adjacent to a respective receiversurface 88. The guides 878 a, 878 b, can have a curved surface 880 and alip 884. The curved surface 880 can be shaped to cooperate with thecurved features 821 of the connecting arm 816. The cooperation betweenthe curved surface 880 and the curved features 821 can allow the topportion 842 to move or translate relative to the connecting arm 816. Thelip 884 can retain the top portion 842 on the connecting arm 816. Thelip 884 can also contact the rail 829 on the connecting arm 816 to aidin guiding the movement of the top portion 842 relative to theconnecting arm 816.

With reference to FIG. 36 , the at least one bore 874 can receive atleast one pin 886 to enable frictional movement between the top portion842 and the connecting arm 816. In one example, the distal end 862 caninclude two bores 874 a, 874 b and two pins 886 a, 886 b. The bores 874a, 874 b can be defined on the distal end 862 can define passageways forreceipt of the pins 886 a, 886 b. Generally, the bores 874 a, 874 b canbe formed so that the passageways extend transverse to the longitudinalaxis L. In one example, the passageways can be defined by the bores 874a, 874 b, so as to extend adjacent to the receiver surface 88 from afirst side 864 a of the distal end 862 to a second side 864 b of thedistal end 862.

A respective one of the pins 886 a, 886 b can be received in arespective one of the bores 874 a, 874 b. The pins 886 a, 886 b can befixed relative to the top portion 842. When the top portion 842 movesrelative to the connecting arm 816, the biasing force from the frictionelement 826 can resist the movement of the top portion 842, which canallow for controlled movement of the top portion 842 relative to theconnecting arm 816. This can enable the surgeon to place the top portion842 in a selected position and the friction between the pins 886 a, 886b and the connecting arm 816 can allow the top portion 842 to remain inthat selected position.

The pins 886 a, 886 b, can be elongated and can include a first end 890and a second end 892. In one example, the pins 886 a, 886 b can have auniform cross-section, however, the pins 886 a, 886 b could have varyingcross-sections to increase the friction between the top portion 842 andthe connecting arm 816. The cross-section of the pins 886 a, 886 b isillustrated herein as being circular, but the pins 886 a, 886 b couldhave any desired cross-section, such as oval, rectangular, square,triangular, trapezoidal, etc. The first end 890 and the second end 892of the pins 886 a, 886 b can include a taper which can allow the firstend 890 and second end 892 of the pins 886 a, 886 b to be containedgenerally wholly within the top portion 842.

The central bore 876 can be defined through the distal end 862 from thereceiver surface 88 to the bottom surface 872. Generally, the centralbore 876 can be sized to receive the connecting arm 816 and the bonefastener 802 (FIG. 36 ).

With reference to FIG. 34 , in order to assemble the multiplanar boneanchor system 800 according to one exemplary method, the bone fastener802 can be inserted through the bore 824 of the connecting arm 816 andpassed through the retention surface 828 so that the bone fastener 802is retained within and can articulate within the connecting arm 816.Then, the connecting arm 816 can be inserted into the top portion 842 ofthe saddle 806. Generally, the connecting arm 816 can be rotated about90° around a main axis M of the connecting arm 816 in order to insertthe connecting arm 816 through the top portion 842 (FIG. 35 ). Theconnecting arm 816 can be rotated back about 90° around the axis M untilthe curved features 821 and straight portions 821 a of the connectingarm 816 are engaged with the curved surface 884 and flat surface 886 ofthe top portion 842. Alternatively, the bone fastener 802 can beinserted into the bore 824 of the connecting arm 816 after theconnecting arm 816 is coupled to the saddle 806.

Next, with reference to FIG. 33 , the pins 886 a, 886 b, can be pressedinto the bores 874 a, 874 b of the top portion 842. The bottom portion840 can then be snap fit about the connecting arm 816 such that thegrooves 854 a-854 d of the bottom portion 840 engage the ribs 836 a-836d of the connecting arm 816. It should be noted that the use of thebottom portion 840 is merely exemplary, as the pins 886 a, 886 b cansolely retain the connecting arm 816 within the top portion 842.

Once assembled, the connecting arm 816 can enable the bone fastener 802to move or rotate within the bore 824 of the connecting arm 816. Withreference to FIG. 36 , the connecting arm 816 can also allow the bonefastener 802 to move or angulate relative to the longitudinal axis L ofthe multiplanar bone anchor system 800. The preferred angle slot 832 ofthe connecting arm 816 can cooperate with the preferred angle slot 850of the bottom portion 840 to enable the bone fastener 802 to move orarticulate to the greater angle A. The top portion 842 of the saddle 806can move or translate relative to the bottom portion 840 and connectingarm 816 to a selected position. The friction between the pins 886 a, 886b and the friction surface 826 of the connecting arm 816 can allow thetop portion 842 to stay in the selected position once moved to theselected position. Thus, when assembled, the multiplanar bone anchorsystem 800 can have at least three degrees of movement or can be movablein at least three planes. For example, the bone fastener 802 can rotateabout the longitudinal axis L. The bone fastener 802 can also pivotrelative to the longitudinal axis L in at least a first direction and asecond direction. The saddle 806 can translate relative to thelongitudinal axis L. By allowing the multiplanar bone anchor system 800to move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 800 as necessary to conform to theanatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system800 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 800 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 800 is secured to theanatomy, the multiplanar coupling system 804 and the saddle 806 can bemoved, pivoted or rotated relative to the bone fastener 802 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be inserted into a desired number of multiplanarbone anchor systems 800.

With the connecting rod 20 positioned in the saddles 806 of themultiplanar bone anchor systems 800, the set screw 22 can be coupled toeach mating portion 84 of each saddle 806. The coupling of the set screw22 can apply a force to the head 810 of the bone fastener 802 to fixedlycouple or lock the position of the bone fastener 802 relative to thesaddle 806.

With reference now to FIGS. 37-39 , in one example, a multiplanar boneanchor system 900 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the multiplanar bone anchor system 900can be similar to the multiplanar bone anchor system 800 described withreference to FIGS. 31-36 , only the differences between the multiplanarbone anchor system 800 and the multiplanar bone anchor system 900 willbe discussed in great detail herein, and the same reference numeralswill be used to denote the same or similar components. The multiplanarbone anchor system 900 can include the bone fastener 802, a multiplanarcoupling arrangement or system 904 and a saddle 906. The multiplanarbone anchor system 900 can define a longitudinal axis L2, and themultiplanar bone anchor system 900 can be configured such that the bonefastener 902 and the saddle 906 can move relative to the longitudinalaxis L2 in multiple planes (FIG. 39 ).

The multiplanar coupling system 904 can include a connecting arm 916.The connecting arm 916 can be composed of any suitable biocompatiblematerial, such as a biocompatible metal, metal alloy, ceramic orpolymer. The connecting arm 916 can be disposed about the head 810 ofthe bone fastener 802 to allow relative movement between the bonefastener 802 and the saddle 906. The connecting arm 916 can be sized tofit within the saddle 906, and can also allow a portion of the saddle906 to move or translate relative to another portion of the saddle 906,as will be discussed in greater detail herein. The connecting arm 916can include a first or upper portion 920, the second or lower portion822 and the bore 824.

The upper portion 920 can be shaped to be received within a portion ofthe saddle 906, and can be generally rectangular with rounded corners.In one example, the upper portion 820 can have opposite curved features821. The opposite curved features 821 can include the generally straightportion 821 a. As will be discussed in greater detail herein, thestraight portion 821 a can cooperate with the saddle 906 to enable thesaddle 906 to move or translate relative to the upper portion 820 of theconnecting arm 916. The upper portion 920 can include at least onefriction surface 926, the retention surface 828 and the rail 829.

With reference to FIG. 37 , the at least one friction surface 926 can beformed on opposite sides of the bore 824. In one example, the at leastone friction surface 926 can comprise a first vertical spring 926 a anda second vertical spring 926 b. It should be noted that although the atleast one friction surface 926 is described and illustrated herein ascomprising two vertical springs, the at least one friction surface 926could comprise a single vertical spring, a frictional coating or otherinterference, which can control the movement of a portion of the saddle906 relative to the connecting arm 916 and another portion of the saddle906, as will be discussed in greater detail herein. The first verticalspring 926 a and the second vertical spring 926 b can be biased againstthe saddle 906 to enable the saddle 906 to be moved in a controlledfashion.

With reference to FIGS. 37-39 , the saddle 906 can be coupled to theconnecting arm 916 and can move or translate relative to the connectingarm 916. In this regard, the saddle 906 can include the first portion orbottom portion 840 and a second portion or top portion 942. The bottomportion 840 can be immovably coupled to the connecting arm 916, and thetop portion 942 can move or translate relative to the bottom portion 840and the connecting arm 916. When the top portion 942 moves relative tothe connecting arm 916, the biasing force from the friction element 926can resist the movement of the top portion 942, which can allow forcontrolled movement of the top portion 942 relative to the connectingarm 916. This can enable the surgeon to place the top portion 942 in aselected position and the friction from the connecting arm 916 can allowthe top portion 942 to remain in that selected position. The top portion942 can be substantially U-shaped and symmetrical with respect to alongitudinal axis L2 defined by the multiplanar bone anchor system 900.The top portion 942 can include the first or proximal end 860 and asecond or distal end 944. The distal end 944 of the top portion 942 canbe generally rectangular, and can include rounded corners to correspondwith the shape of the bottom portion 940. The distal end 944 can includethe first or receiver surface 88, the second or bottom surface 872 andthe central bore 876.

With reference to FIG. 34 , in order to assemble the multiplanar boneanchor system 900 according to one exemplary method, the bone fastener802 can be inserted through the bore 824 of the connecting arm 916 andpassed through the retention surface 828 so that the bone fastener 802is retained within and can articulate within the connecting arm 916.Then, the connecting arm 916 can be inserted into the top portion 842 ofthe saddle 906. Generally, the connecting arm 916 can be rotated about90° around a main axis of the connecting arm 916 in order to insert theconnecting arm 916 through the top portion 942. The connecting arm 916can be rotated back about 90° around the main axis until the curvedfeatures 821 and straight portions 821 a of the connecting arm 916 areengaged with the curved surface 884 and flat surface 886 of the topportion 942. Alternatively, the bone fastener 802 can be inserted intothe bore 824 of the connecting arm 916 after the connecting arm 916 iscoupled to the saddle 806.

Next, the bottom portion 840 can then be snap fit about the connectingarm 916 such that the grooves 854 a-854 d of the bottom portion 840engage the ribs 836 a-836 d of the connecting arm 916.

Once assembled, the connecting arm 916 can enable the bone fastener 802to move or rotate within the bore 824 of the connecting arm 916. Withreference to FIG. 39 , the connecting arm 916 can also allow the bonefastener 802 to move or angulate relative to the longitudinal axis L2 ofthe multiplanar bone anchor system 900. The preferred angle slot 832 ofthe connecting arm 916 can cooperate with the preferred angle slot 850of the bottom portion 840 to enable the bone fastener 802 to move orarticulate to the greater angle A. The top portion 942 of the saddle 906can move or translate relative to the bottom portion 840 and connectingarm 916 to a selected position. The friction from the friction surface926 of the connecting arm 916 can allow the top portion 942 to stay inthe selected position once moved to the selected position. Thus, whenassembled, the multiplanar bone anchor system 900 can have at leastthree degrees of movement or can be movable in at least three planes.For example, the bone fastener 802 can rotate about the longitudinalaxis L2. The bone fastener 802 can also pivot relative to thelongitudinal axis L2 in at least a first direction and a seconddirection. The saddle 806 can translate relative to the longitudinalaxis L2. By allowing the multiplanar bone anchor system 900 to move inat least three planes, the surgeon can manipulate the multiplanar boneanchor system 900 as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system900 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 900 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 900 is secured to theanatomy, the multiplanar coupling system 904 and the saddle 906 can bemoved, pivoted or rotated relative to the bone fastener 802 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be inserted into a desired number of multiplanarbone anchor systems 900.

With the connecting rod 20 positioned in the saddles 906 of themultiplanar bone anchor systems 900, the set screw 22 can be coupled toeach mating portion 84 of each saddle 906. The coupling of the set screw22 to the saddle 906 can apply a force to the head 810 of the bonefastener 802 to fixedly couple or lock the position of the bone fastener802 relative to the saddle 906.

With reference now to FIGS. 40 and 41 , in one example, a multiplanarbone anchor system 950 can be employed with the connecting rod 20 torepair a damaged portion of an anatomy. As the multiplanar bone anchorsystem 950 can be similar to the multiplanar bone anchor system 800described with reference to FIGS. 31-36 , only the differences betweenthe multiplanar bone anchor system 800 and the multiplanar bone anchorsystem 950 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 950 can include a bonefastener 952, a multiplanar coupling arrangement or system 954 and asaddle 956. The multiplanar bone anchor system 950 can define alongitudinal axis L3, and the multiplanar bone anchor system 950 can beconfigured such that the bone fastener 952 and the saddle 956 can moverelative to the longitudinal axis L3 in multiple planes. It should benoted that although the multiplanar bone anchor system 950 is describedand illustrated herein as not including a lock ring, a lock ring couldbe employed with the multiplanar bone anchor system 950, if desired.

The bone fastener 952 can be configured to engage the anatomy to couplethe multiplanar bone anchor system 900 to the anatomy. The bone fastener952 can be composed of any suitable biocompatible material, such astitanium, stainless steel, biocompatible metals, metal alloys, polymers,etc. The bone fastener 952 can include a proximal end or head 960 (FIG.41 ) and the distal end or shank 32. The head 960 can be substantiallyspherical, and can define a bearing surface 962 and the driverconnection feature 34.

The bearing surface 962 can be formed adjacent to the shank 32 of thebone fastener 952. The bearing surface 962 can contact the multiplanarcoupling system 954 to enable the bone fastener 952 to move or angulaterelative to the longitudinal axis L3. The bearing surface 962 can alsocooperate with the multiplanar coupling system 954 to enable the bonefastener 952 to move or rotate relative to the saddle 956 and can alsoallow the saddle 956 to move relative to the bone fastener 952, as willbe discussed in greater detail herein.

In one example, the multiplanar coupling system 954 can include a firstpin 966 and a second pin 968. The first pin 966 can be positionedsubstantially opposite the second pin 968 within the saddle 956. Thefirst pin 966 and the second pin 968 can define rails or guides for thesaddle 956 to move relative to the bone fastener 952, while alsoallowing the bone fastener 952 to freely rotate and articulate relativeto the saddle 956. The first pin 966 and the second pin 968 can alsoserve to couple the bone fastener 952 to the saddle 956 and retain thebone fastener 952 within the saddle 956. The first pin 966 and thesecond pin 968 can be composed of any suitable biocompatible material,such as a biocompatible metal. Generally, the first pin 966 and thesecond pin 968 can be press-fit into the saddle 956, and thus, the firstpin 966 and the second pin 968 can have a diameter that is substantiallyequal or slightly larger than a diameter of a first pin bore 970 and asecond pin bore 972 defined in the saddle 956. Alternatively, the firstpin 966 and the second pin 968 can be coupled to the saddle 956 throughany suitable technique, such as welding, swaging, etc. In addition, itshould be noted that although the multiplanar coupling system 954 isdescribed and illustrated herein as including the first pin 966 and thesecond pin 968, only one pin could be employed, if desired.

The saddle 956 can move or translate relative the bone fastener 952along the first pin 966 and the second pin 968. The saddle 956 can besubstantially U-shaped and symmetrical with respect to the longitudinalaxis L3 defined by the multiplanar bone anchor system 950 (FIG. 40 ).The saddle 956 can include a first or proximal end 974 and a second ordistal end 976. In one example, the proximal end 974 can include a firstarm 978 and a second arm 980. The first arm 978 and second arm 980 canextend upwardly from the distal end 976 to define the U-shape. Each ofthe first arm 978 and the second arm 980 can include the mating portion84, a cavity 982 and the connector feature 870.

The cavity 982 can be defined in each interior surface 978 a, 980 a ofthe first arm 978 and the second arm 980. The cavity 982 can provideclearance for the movement or articulation of the saddle 956 relative tothe bone fastener 952. In this regard, the cavity 982 can be configuredso as to allow the saddle 956 to move over the head 960 of the bonefastener 952, which can provide a range of motion for the saddle 956relative to the bone fastener 952. Thus, contact between the head 960 ofthe bone fastener 952 and the cavity 982 can act as a stop to limit themovement or translation of the saddle 956 relative to the bone fastener952, however, other techniques could be used to stop or limit themovement or translation of the saddle 956 relative to the bone fastener952, such as features formed on the first pin 966 and/or the second pin968.

With reference to FIG. 40 , the distal end 976 of the saddle 956 can begenerally rectangular, and can include rounded corners. It should benoted that the shape of the distal end 976 of the saddle 956 does nothave to be generally rectangular, but could be generally square,cylindrical, oval, etc. The distal end 976 can include the first orreceiver surface 88, a second or bottom surface 984 and a central bore986. The bottom surface 984 can include the first pin bore 970 and thesecond pin bore 972. The first pin bore 970 and the second pin bore 972can be defined on substantially opposite sides of the saddle 956 and canextend along an axis substantially transverse to the longitudinal axisL3. In one example, the first pin bore 970 and the second pin bore 972can be defined to extend from a first side 956 a of the saddle 956 to asecond side 956 b of the saddle 956. The first pin bore 970 and thesecond pin bore 972 can have a diameter that can be substantially equalor less than the diameter of the first pin 966 and the second pin 968 toenable the first pin 966 and the second pin 968 to be press-fit into thesaddle 956, but allow the saddle 956 to move or translate relative tothe bone fastener 952 on the first pin 966 and the second pin 968. Inone example, the first pin bore 970 and the second pin bore 972 can havean open periphery over a length of the first pin bore 970. The openperiphery of the first pin bore 970 and the second pin bore 972 canenable the bone fastener 952 to contact the first pin 966 and the secondpin 968 to move about the first pin 966 and the second pin 968, whileallowing the first pin 966 and the second pin 968 to retain the bonefastener 952 within the saddle 956.

The central bore 986 can be defined through the distal end 976 from thereceiver surface 88 to the bottom surface 984. Generally, the centralbore 986 can be sized to receive the bone fastener 952 and to allow thebone fastener 952 to move, rotate or articulate about the central bore986.

With continued reference to FIGS. 40 and 41 , in order to assemble themultiplanar bone anchor system 950 according to one exemplary method,the bone fastener 952 can be inserted through the central bore 986 ofthe saddle 956. Then, the first pin 966 and the second pin 968 can bepressed into the first pin bore 970 and the second pin bore 972 toretain the bone fastener 952 within the saddle 956. The first pin 966and the second pin 968 can allow the bone fastener 952 to move, rotateand articulate about the longitudinal axis L3, and can allow the saddle956 to move or translate relative to the bone fastener 952. Thus, whenassembled, the multiplanar bone anchor system 950 can have at leastthree degrees of movement or can be movable in at least three planes.For example, the bone fastener 952 can rotate about the longitudinalaxis L3. The bone fastener 952 can also pivot relative to thelongitudinal axis L3 in at least a first direction and a seconddirection. The saddle 956 can translate relative to the longitudinalaxis L3. By allowing the multiplanar bone anchor system 950 to move inat least three planes, the surgeon can manipulate the multiplanar boneanchor system 950 as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system950 in a fixation procedure can be similar to the surgical insertion andinsertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 950 will not be discussed in great detail herein. Briefly,however, once the bone fastener 952 is secured to the anatomy, thesaddle 956 can be moved, pivoted or rotated relative to the bonefastener 952 into the desired alignment for the fixation procedure. Oncethe aligned, the connecting rod 20 can be inserted into a desired numberof multiplanar bone anchor systems 950.

With the connecting rod 20 positioned in the saddles 956 of themultiplanar bone anchor systems 950, the set screw 22 can be coupled toeach mating portion 84 of each saddle 956. The coupling of the set screw22 to the saddle 956 can apply a force to the head 960 of the bonefastener 952 to fixedly couple or lock the position of the bone fastener952 relative to the saddle 956.

With reference now to FIGS. 42-45 , in one example, a multiplanar boneanchor system 1000 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1000 can be similar to the multiplanar bone anchor system 10 describedwith reference to FIGS. 1-8 , only the differences between themultiplanar bone anchor system 10 and the multiplanar bone anchor system1000 will be discussed in great detail herein, and the same referencenumerals will be used to denote the same or similar components. Themultiplanar bone anchor system 1000 can include a bone fastener 1002, alock ring 1004 and a saddle 1006. The multiplanar bone anchor system1000 can define a longitudinal axis L4, and the multiplanar bone anchorsystem 1000 can be configured such that the bone fastener 1002 and thesaddle 1006 can move relative to the longitudinal axis L4 in multipleplanes.

With continued reference to FIGS. 42-45 , the bone fastener 1002 can beconfigured to engage the anatomy to couple the multiplanar bone anchorsystem 1000 to the anatomy. The bone fastener 1002 can be composed ofany suitable biocompatible material, such as titanium, stainless steel,biocompatible polymers, etc. The bone fastener 1002 can include aproximal end or head 1008 (FIGS. 44 and 45 ) and the distal end or shank32 (FIG. 45 ). With reference to FIGS. 43-45 , the head 1008 can begenerally spherical, and can include the driver connection feature 34.

With reference to FIGS. 43-45 , the lock ring 1004 can be positionedabout the head 1008 of the bone fastener 1002 and coupled to the saddle1006. The lock ring 1004 can lock the bone fastener 1002 relative to thesaddle 1006 via a force applied by the connecting rod 20. With referenceto FIG. 43 , the lock ring 1004 can be generally cylindrical, and canhave a height H1. The height H1 can be sized to extend above thereceiver surface 88 of the saddle 1006, as illustrated in FIG. 42 , sothat coupling the connecting rod 20 to the saddle 1006 can compress thelock ring 1004 onto the head 1008 of the bone fastener 1002. Withreference to FIGS. 43-45 , the lock ring 1004 can include a proximal end1010, a distal end 1012, a bearing surface 1014 and a bore 1016.

With reference to FIG. 43 , the proximal end 1010 can include one ormore projections or teeth 1018. The teeth 1018 can be formed along aproximalmost surface 1010 a of the proximal end 1010. The teeth 1018 canengage the connecting rod 20 to assist in coupling the connecting rod 20to the saddle 1006. The distal end 1012 can include at least one tab1020. In one example, with reference to FIG. 45 , the at least one tab1020 can comprise two tabs 1020 a, 1020 b. The tabs 1020 a, 1020 b canextend from the distal end 1012 and can be spaced about 180° apart fromeach other about a circumference of the lock ring 1004. The tabs 1020 a,1020 b can include a locking tab 1021, which can engage a portion of thesaddle 1006 to couple the lock ring 1004 to the saddle 1006. The tabs1020 a, 1020 b can also couple a portion of the saddle 1006 to anotherportion of the saddle 1006.

The bearing surface 1014 can be formed adjacent to the distal end 1012of the lock ring 1004 along a portion of the bore 1016. In one example,the bearing surface 1014 can comprise an arcuate ring defined about thebore 1016, which is configured to enable the head 1008 of the bonefastener 1002 to move, rotate and articulate relative to the lock ring1004.

With reference to FIGS. 43-45 , the bore 1016 can be disposed about acentral axis of the lock ring 1004. The bore 1016 can extend from theproximal end 1010 to the distal end 1012. The bearing surface 1014 canbe formed about the bore 1016. The bore 1016 can enable a driver tointerface with the driver connection feature 34 formed on the head 1008of the bone fastener 1002.

With reference to FIGS. 42-45 , the saddle 1006 can include a firstportion or bottom portion 1022 and a second portion or top portion 1024.The top portion 1024 can move or translate relative to the bottomportion 1022. With reference to FIG. 43 , the bottom portion 1022 caninclude a first or proximal end 1026, a second or distal end 1028 and abore 1030.

The proximal end 1026 can be generally rectangular, and can includerounded corners. The proximal end 1026 can be coupled to the top portion1024 (FIG. 42 ). The proximal end 1026 can define at least one rail1032. Generally, the top portion 1024 can move or translate along the atleast one rail 1032. In one example, the proximal end 1026 can definetwo rails 1032 a, 1032 b, which can be positioned on opposite sides ofthe bore 1030. As will be discussed, the lock ring 1004 can define orlimit the translation of the top portion 1024 relative to the bottomportion 1022.

With reference to FIGS. 44 and 45 , the distal end 1028 can include apreferred angle slot 1034. The preferred angle slot 1034 can be formedthrough at least one side of the distal end 1028 and can be incommunication with the bore 1030. The preferred angle slot 1034 can bedefined through the bottom portion 1022 at any desired location. Withreference to FIG. 44 , the preferred angle slot 1034 can enable the bonefastener 1002 to articulate to a greater angle A2 relative to thelongitudinal axis L4. In this regard, the bone fastener 1002 canarticulate to an angle A3 relative to the longitudinal axis L4 in anarea of the bottom portion 1022 that does not include the preferredangle slot 1034. The angle A3 can be less than the greater angle A2.Alternatively, the distal end 1028 could be devoid of the preferredangle slot, if desired.

With reference to FIG. 45 , the bore 1030 can be defined through thebottom portion 1022 from the proximal end 1026 to the distal end 1028.The bore 1030 can be sized to receive the lock ring 1004 and the bonefastener 1002 therein. The bore 1030 can include a bearing surface 1036and at least one groove 1038. The bearing surface 1036 can be configuredto contact the head 1008 of the bone fastener 1002 to enable the bonefastener 1002 to move, rotate or articulate relative to the bottomportion 1022. Thus, the bearing surface 1036 can be generally arcuate.The at least one groove 1038 can be formed in a sidewall of the bore1030, and can mate with the at least one tab 1020. In one example, theat least one groove 1038 can comprise two grooves 1038 a, 1038 b. Thegrooves 1038 a, 1038 b can be spaced about 180° apart from each otherabout a circumference of the bore 1030. A respective one of the tabs1020 a, 1020 b can engage a respective one of the grooves 1038 a, 1038 bto secure the lock ring 1004 to the saddle 1006, and to secure thebottom portion 1022 to the top portion 1024.

With reference to FIG. 42 , the top portion 1024 of the saddle 1006 canbe coupled to the at least one rail 1032 of the proximal end 1026 of thebottom portion 1022 so that the top portion 1024 can move relative tothe bottom portion 1022. The top portion 1024 can be substantiallyU-shaped and symmetrical with respect to a longitudinal axis L4 definedby the multiplanar bone anchor system 1000. With reference to FIG. 43 ,the top portion 1024 can include a first or proximal end 1040 and asecond or distal end 1042. In one example, the proximal end 1040 caninclude a first arm 1044 and a second arm 1046. The first arm 1044 andsecond arm 1046 can extend upwardly from the distal end 1042 to definethe U-shape. Each of the first arm 1044 and the second arm 1046 caninclude the mating portion 84.

With reference to FIG. 43 , the distal end 1042 of the top portion 1024can be generally rectangular, and can include the receiver surface 88,at least one guide 1050, an assembly slot 1052, an assembly aperture1054 and a central bore 1056. It should be noted that the shape of thedistal end 1042 does not have to be generally rectangular, but could begenerally square, cylindrical, oval, etc. The at least one guide 1050can cooperate with the at least one rail 1032 to enable the top portion1024 to move relative to the bottom portion 1022. In one example, the atleast one guide 1050 can comprise two guides 1050 a, 1050 b. The guides1050 a, 1050 b can allow the top portion 1024 to move along the rails1032 a, 1032 b to enable the top portion 1024 to move or translaterelative to the bottom portion 1022. It should be noted that while theguides 1050 a, 1050 b and the rails 1032 a, 1032 b are illustratedherein as comprising a dovetail arrangement (FIG. 42 ), any type ofarrangement can be used to enable the top portion 1024 to move relativeto the bottom portion 1022.

With reference to FIG. 44 , the assembly slot 1052 can be defined fromthe assembly aperture 1054 to an opposite side 1024 a of the top portion1024. The assembly slot 1052 can be sized to enable the top portion 1024to pass over the bottom portion 1022 to couple the top portion 1024 tothe bottom portion 1022, as will be discussed herein. It should be notedthat although one assembly slot 1052 is described and illustratedherein, more than one assembly slot 1052 could be defined in the distalend 1042.

The assembly aperture 1054 can be defined through a sidewall 1024 b ofthe top portion 1024. The assembly aperture 1054 can have a width, whichcan be less than a width of the assembly slot 1052. Generally, the widthof the assembly aperture 1054 can be sized to enable the top portion1024 to pass over the head 1008 of the bone fastener 1002, but cancontact the lock ring 1004 when the lock ring 1004 is assembled withinthe saddle 1006 to prevent the disassembly of the top portion 1024 andthe bottom portion 1022. As will be discussed, the assembly aperture1054 can cooperate with the assembly slot 1052 to enable the top portion1024 to be coupled to the bottom portion 1022.

The central bore 1056 can be defined through the distal end 1042 fromthe receiver surface 88 to the guides 1050 a, 1050 b. Generally, thecentral bore 1056 can be sized to receive the bone fastener 1002 and thetabs 1020 a. 1020 b of the lock ring 1004.

With reference to FIGS. 42-45 , in order to assemble the multiplanarbone anchor system 1000 according to one exemplary method, the bonefastener 1002 can be inserted through the bore 1030 of the bottomportion 1022 of the saddle 1006. Initially, the bone fastener 1002 canrest within a pocket defined by the bearing surface 1036 of the bore1030 (FIG. 44 ). Then, the lock ring 1004 can be inserted into thecentral bore 1056 of the top portion 1024 of the saddle 1006 and can bepushed into the central bore 1056 from the distal end 1042. With thelock ring 1004 positioned within the top portion 1024, the top portion1024 can be slid onto the bottom portion 1022 with the rails 1032 a,1032 b engaging the grooves 1050 a, 1050 b. In one example, the topportion 1024 can be slid onto the bottom portion 1022 in the directionof the assembly slot 1052 such that the assembly slot 1052 contacts thebottom portion 1022 first. The assembly slot 1052 can be sized to enablethe top portion 1024 to pass over the head 1008 of the bone fastener1002. Once the top portion 1024 is assembled onto the bottom portion1022, the lock ring 1004 can be pushed down until the tabs 1020 a, 1020b of the lock ring 1004 engage the grooves 1050 a, 1050 b of the bottomportion 1022 (FIG. 45 ).

When assembled, the multiplanar bone anchor system 1000 can have atleast three degrees of movement or can be movable in at least threeplanes. In this regard, the bone fastener 1002 can move or rotate aboutthe longitudinal axis L4 and can also move or articulate relative to thelongitudinal axis L4. The top portion 1024 can move or translaterelative to the bottom portion 1022 in a direction transverse to thelongitudinal axis L4. By allowing the multiplanar bone anchor system1000 to move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 1000 as necessary to conform to theanatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1000 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1000 will not be discussed in great detail herein. Briefly,however, once the bone fastener 1002 is secured to the anatomy, thesaddle 1006 can be moved, pivoted or rotated relative to the bonefastener 1002 into the desired alignment for the fixation procedure.Once the aligned, the connecting rod 20 can be inserted into a desirednumber of multiplanar bone anchor systems 1000.

With the connecting rod 20 positioned in the saddles 1006 of themultiplanar bone anchor systems 1000, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1006. The coupling of the setscrew 22 to the saddle 1006 can apply a force to the head 1008 of thebone fastener 1002 to fixedly couple or lock the position of the bonefastener 1002 relative to the saddle 1006.

With reference now to FIGS. 46-49 , in one example, a multiplanar boneanchor system 1100 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1100 can be similar to the multiplanar bone anchor system 10 describedwith reference to FIGS. 1-8 , only the differences between themultiplanar bone anchor system 10 and the multiplanar bone anchor system1100 will be discussed in great detail herein, and the same referencenumerals will be used to denote the same or similar components. Themultiplanar bone anchor system 1100 can include a bone fastener 1102, alock ring 1104, a multiplanar coupling arrangement or system 1106 and asaddle 1108. The multiplanar bone anchor system 1100 can define alongitudinal axis L5, and the multiplanar bone anchor system 1100 can beconfigured such that the bone fastener 1102 and the saddle 1108 can moverelative to the longitudinal axis L5 in multiple planes.

With reference to FIGS. 46 and 47 , the bone fastener 1102 can beconfigured to engage the anatomy to couple the multiplanar bone anchorsystem 1100 to the anatomy. The bone fastener 1102 can be composed ofany suitable biocompatible material, such as titanium, stainless steel,biocompatible polymers, etc. The bone fastener 1102 can include aproximal end or head 1110 (FIG. 47 ) and the distal end or shank 32(FIG. 46 ). With reference to FIG. 47 , the head 1110 can be generallyspherical, and can include the driver connection feature 34.

With reference to FIGS. 47-49 , the lock ring 1104 can be positionedabout the head 1110 of the bone fastener 1102. As will be discussedherein, the lock ring 1104 can lock at least one of the bone fastener1102 and the multiplanar coupling system 1106 relative to the saddle1108 via a force applied by the connecting rod 20. The lock ring 1104can be generally cylindrical, and can have a height H4. The height H4can be sized to extend above the receiver surface 88 of the saddle 1108so that coupling the connecting rod 20 to the saddle 1108 can compressthe lock ring 1104 onto the head 1110 of the bone fastener 1102 (FIG. 46). With reference to FIG. 47 , the lock ring 1104 can include a proximalend 1112, a distal end 1114 and a bore 1116.

The proximal end 1112 can bear against the connecting rod 20 when theconnecting rod 20 is coupled to the saddle 1108. The proximal end 1112can include a slot 1118 and a plurality of teeth 1119. The slot 1118 canenable a tool to engage the lock ring 1104 to move the lock ring 1104within the saddle 1108. As will be discussed, the movement of the lockring 1104 within the saddle 1108 can enable the user to select aposition for the bone fastener 1102 to articulate to a greater angle.The teeth 1119 can engage or bite into the connecting rod 20 to assistin coupling the connecting rod 20 to the saddle 1108.

The distal end 1114 can include a collar 1120 and a preferred tab 1122.The collar 1120 can extend about a circumference of the lock ring 1104and can contact a portion of the saddle 1108 to assist in coupling theportion of the saddle 1108 to the connecting arm 1130. As illustrated inFIG. 49 , the preferred tab 1122 can be keyed to mate with a preferredslot 1124 defined in a connecting arm 1130. The engagement of thepreferred tab 1122 with the preferred slot 1124 can enable the lock ring1104 to move in concert with the connecting arm 1130. The coordinatedmovement of the lock ring 1104 and the connecting arm 1130 can allow theuser to move the lock ring 1104 to adjust a position of a preferredangle slot 1126 defined in the connecting arm 1130, as will be discussedherein.

With reference to FIG. 49 , the bore 1116 can be defined from theproximal end 1112 to the distal end 1114. The bore 1116 can enable aninstrument to engage the driver connection feature 34 when themultiplanar bone anchor system 1100 is assembled. It should be notedthat the use of the driver connection feature 34 is merely exemplary, asa tool could engage the lock ring 1104 couple the bone fastener 1102 tothe anatomy. The bore 1116 can include a bearing surface 1128. Thebearing surface 1128 can generally be formed adjacent to the distal end1114. The bearing surface 1128 can be arcuate and generally concave toslidably engage the spherical head 1110 of the bone fastener 1102. Thebearing surface 1128 can also enable the lock ring 1104 to move orarticulate relative to the multiplanar coupling system 1106, as will bediscussed herein.

In one example, with reference to FIG. 47 , the multiplanar couplingsystem 1106 can include a connecting arm 1130. The connecting arm 1130can be disposed about a head 1110 of the bone fastener 1102 to enablethe bone fastener 1102 to move or articulate relative to the saddle1108, as shown in FIG. 48 . The connecting arm 1130 can be annular, andcan be sized to receive a portion of the saddle 1108 and the lock ring1104. With reference to FIGS. 47 and 49 , the connecting arm 1130 caninclude the preferred slot 1124 (FIG. 49 ), the preferred angle slot1126 and a bore 1132.

With reference to FIG. 49 , the preferred slot 1124 can be defined nearthe preferred angle slot 1126. The preferred slot 1124 can be configuredto receive the preferred tab 1122 to enable the operator to control thelocation of the preferred angle slot 1126. The preferred angle slot 1126can enable the bone fastener 1102 to articulate to a greater angle A4relative to the longitudinal axis L5. In one example, the preferredangle slot 1126 can comprise a cut-out in a portion of the connectingarm 1130, which can be in communication with the bore 1132 to enable thebone fastener 1102 to articulate to the greater angle A4. In thisregard, the bone fastener 1102 can articulate to an angle A5 relative tothe longitudinal axis L5 in an area of the connecting arm 1130 that doesnot include the preferred angle slot 1126. The angle A5 can be less thanthe greater angle A4.

With reference to FIG. 48 , the bore 1132 can have a first portion 1134and a second portion 1136. The first portion 1134 can include a lip 1138and a recess 1140 for coupling a portion of the saddle 1108 to theconnecting arm 1130. The lip 1138 can be formed adjacent to aproximalmost end 1130 a of the connecting arm 1130. The lip 1138 cancooperate with a portion of the saddle 1108 to couple the saddle 1108 tothe connecting arm 1130. The recess 1140 can be sized to receive aportion of the saddle 1108, a portion of the lock ring 1104 and the head1110 of the bone fastener 1102.

The second portion 1136 of the bore 1132 can be sized to receive thehead 1110 of the bone fastener 1102. The second portion 1136 can includea bearing surface 1136 a. The bearing surface 1136 a can contact thehead 1110 of the bone fastener 1102 to enable the bone fastener 1102 tomove, rotate or articulate relative to the connecting arm 1130.

With reference to FIG. 47 , the saddle 1108 can include a first portionor bottom portion 1142 and a second portion or top portion 1144. The topportion 1144 can move or translate relative to the bottom portion 1142.The bottom portion 1142 can include a first or proximal end 1146, asecond or distal end 1148 and a bore 1150. The bore 1150 can be definedthrough the bottom portion 1142. The bore 1150 can be sized to receivethe lock ring 1104 therein (FIG. 48 ).

The proximal end 1146 can define at least one rail 1152. In one example,the proximal end 1146 can include two rails 1152 a, 1152 b, which can bepositioned on substantially opposite sides of the bottom portion 1142.Generally, the top portion 1144 can move or translate along the rails1152 a, 1152 b.

The distal end 1148 can include at least one locking tab 1154. In oneexample, the distal end 1148 can include four locking tabs 1154 a-1154d, which can be spaced about a circumference of the bottom portion 1142.The locking tabs 1154 a-1154 d can include an edge 1156, which canengage the lip 1138 of the connecting arm 1130 to couple the bottomportion 1142 to the connecting arm 1130 (FIGS. 48 and 49 ).

With reference to FIGS. 47 and 48 , the top portion 1144 of the saddle1108 can be coupled to the rails 1152 a, 1152 b of the proximal end 1146of the bottom portion 1142 so that the top portion 1144 can moverelative to the bottom portion 1142. The top portion 1144 can besubstantially U-shaped and symmetrical with respect to a longitudinalaxis L5 defined by the multiplanar bone anchor system 1100 (FIG. 46 ).The top portion 1144 can include the first or proximal end 76 and asecond or distal end 1160.

With reference to FIG. 47 , the distal end 1160 of the top portion 1144can be generally rectangular, and can include the first or a receiversurface 88, a second or bottom surface 1162 and a central bore 1164. Itshould be noted that the shape of the distal end 1160 does not have tobe generally rectangular, but could be generally square, cylindrical,oval, etc. The central bore 1164 can be defined through the distal end1160 from the receiver surface 88 to the bottom surface 1162. Generally,the central bore 1164 can be sized to receive the lock ring 1104 (FIG.48 ).

With reference to FIGS. 47 and 48 , the bottom surface 1162 can includeat least one or more guides 1166. In this example, the bottom surface1162 can include two guides 1166 a, 1166 b, The guides 1166 a, 1166 bcan slidably couple the top portion 1144 to the bottom portion 1142. Inthis regard, each guides 1166 a, 1166 b can cooperate with a respectiveone of the rails 1152 a, 1152 b to enable the top portion 1144 of thesaddle 1108 to move or translate relative to the bottom portion 1142 ofthe saddle 1108. Generally, the guides 1166 a, 1166 b can cooperate withthe rails 1152 a, 1152 b to create a dovetail relationship. It should beunderstood, however, that any suitable relationship or technique couldbe used to enable the top portion 1144 to move or translate relative tothe bottom portion 1142.

In addition, it should be noted that the lock ring 1104 can define orlimit the translation of the top portion 1144 relative to the bottomportion 1142. In this regard, with reference to FIG. 49 , the cavity 86can be defined in each interior surface 80 b, 82 b of the first arm 80and second arm 82 of the top portion 1144 of the saddle 1108. The cavity86 can provide clearance for the movement or articulation of the topportion 1144 relative to the bottom portion 1142 of the saddle 1108.Generally, the cavity 86 can be defined so as to allow the top portion1144 to move over a portion of the lock ring 1104, which can provide arange of motion for the top portion 1144 relative to the bottom portion1142. Thus, contact between the lock ring 1104 and the cavity 86 can actas a stop to limit the movement or translation of the top portion 1144relative to the bottom portion 1142, however, other techniques could beused to stop or limit the movement or translation of the top portion1144 relative to the bottom portion 1142.

With reference to FIG. 47 , in order to assemble the multiplanar boneanchor system 1100 according to one exemplary method, the bone fastener1102 can be inserted through the bore 1132 of the connecting arm 1130.Then, the bottom portion 1142 of the saddle 1108 can be snap-fit intothe connecting arm 1130 with the lock ring 1104 inserted into the bottomportion 1142 and positioned such that the preferred tab 1122 engages thepreferred slot 1124 of the connecting arm 1130 so that the edge 1156 ofthe locking tabs 1154 a-1154 d engage the lip 1138 of the connecting arm1130 (FIG. 48 ). The guides 1162 a, 1162 b of the top portion 1144 canbe slid onto the rails 1152 a, 1152 b of the bottom portion 1142 tocouple the top portion 1144 to the bottom portion 1142.

When assembled, the multiplanar bone anchor system 1100 can have atleast three degrees of movement or can be movable in at least threeplanes. In this regard, the bone fastener 1102 can move or rotate aboutthe longitudinal axis L5 and can also move or articulate relative to thelongitudinal axis L5. The top portion 1144 can move or translaterelative to the bottom portion 1142 in a direction transverse to thelongitudinal axis L5. By allowing the multiplanar bone anchor system1100 to move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 1100 as necessary to conform to theanatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1100 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1100 will not be discussed in great detail herein. Briefly,however, once the bone fastener 1102 is secured to the anatomy, thesaddle 1108 can be moved, pivoted or rotated relative to the bonefastener 1102 into the desired alignment for the fixation procedure.Once the aligned, the connecting rod 20 can be inserted into a desirednumber of multiplanar bone anchor systems 1100.

With the connecting rod 20 positioned in the saddles 1108 of themultiplanar bone anchor systems 1100, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1108. The coupling of the setscrew 22 to the saddle 1108 can apply a force to the lock ring 1104 tofixedly couple or lock the position of the bone fastener 1102 relativeto the saddle 1108.

With reference now to FIGS. 50-53 , in one example, a multiplanar boneanchor system 1200 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1200 can be similar to the multiplanar bone anchor system 1100 describedwith reference to FIGS. 46-49 , only the differences between themultiplanar bone anchor system 1100 and the multiplanar bone anchorsystem 1200 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1200 can include the bonefastener 1102, a lock ring 1204, a multiplanar coupling arrangement orsystem 1206 and a saddle 1208. The multiplanar bone anchor system 1200can define a longitudinal axis L6, and the multiplanar bone anchorsystem 1200 can be configured such that the bone fastener 1102 and thesaddle 1208 can move relative to the longitudinal axis L6 in multipleplanes.

With reference to FIGS. 51-53 , the lock ring 1204 can be positionedabout the head 1110 of the bone fastener 1102. As will be discussedherein, the lock ring 1204 can lock at least one of the bone fastener1102 and the multiplanar coupling system 1206 relative to the saddle1208 via a force applied by the connecting rod 20. The lock ring 1204can be generally cylindrical, and can have a height H6. The height H6can be sized to extend above the receiver surface 88 of the saddle 1208so that coupling the connecting rod 20 to the saddle 1208 can compressthe lock ring 1204 onto the head 1110 of the bone fastener 1102. Withreference to FIG. 51 , the lock ring 1204 can include a proximal end1205, the distal end 1114 and the bore 1116. The proximal end 1205 canbear against the connecting rod 20 when the connecting rod 20 is coupledto the saddle 1208. The proximal end 1205 can include the slot 1118.Although not illustrated herein, the lock ring 1204 can include teethformed along the proximal end 1205, if desired.

In one example, the multiplanar coupling system 1206 can include aconnecting arm 1210. The connecting arm 1210 can be disposed about thehead 1110 of the bone fastener 1102 to enable the bone fastener 1102 tomove or articulate relative to the saddle 1208. The connecting arm 1210can be annular, and can be sized to receive a portion of the saddle 1208and the lock ring 1104 (FIG. 52 ). With reference to FIG. 51 , theconnecting arm 1210 can include the preferred slot 1124, the preferredangle slot 1126 and a bore 1212.

With reference to FIG. 52 , the bore 1212 can have a first portion 1214and the second portion 1136. The first portion 1214 can include aplurality of threads 1216 and a recess 1217 for coupling a portion ofthe saddle 1208 to the connecting arm 1210. The threads 1216 can beformed adjacent to a proximalmost end 1210 a of the connecting arm 1210and can extend about a circumference of the connecting arm 1210. Thethreads 1216 can cooperate with a portion of the saddle 1208 to couplethe saddle 1208 to the connecting arm 1210.

With reference to FIGS. 51-53 , the saddle 1208 can include a firstportion or bottom portion 1218 and the second portion or top portion1144. The top portion 1144 can move or translate relative to the bottomportion 1218. With reference to FIG. 51 , the bottom portion 1218 caninclude the first or proximal end 1146, a second or distal end 1220 andthe bore 1150.

The distal end 1220 can include a plurality of threads 1222 formed aboutan exterior of the bottom portion 1218. The plurality of threads 1222can extend from the proximal end 1146 to the distal end 1220 and canengage the threads 1216 of the connecting arm 1210 to couple the bottomportion 1218 to the connecting arm 1210, as illustrated in FIGS. 52 and53 .

With reference to FIG. 51 , in order to assemble the multiplanar boneanchor system 1200 according to one exemplary method, the bone fastener1102 can be inserted through the bore 1132 of the connecting arm 1210.Then, the threads 1222 of the bottom portion 1218 of the saddle 1208 canbe threaded into the threads 1216 of the connecting arm 1210 to couplethe bottom portion 1218 to the connecting arm 1210 with the lock ring1204 assembled to the bottom portion 1218 and the preferred tab 1122aligned with the preferred slot 1124 of the connecting arm 1210 (FIG. 52). The guides 1162 a, 1162 b of the top portion 1144 can be slid ontothe rails 1152 a, 1152 b of the bottom portion 1218 to couple the topportion 1144 to the bottom portion 1218 (FIG. 53 ).

When assembled, the multiplanar bone anchor system 1200 can have atleast three degrees of movement or can be movable in at least threeplanes. In this regard, the bone fastener 1102 can move or rotate aboutthe longitudinal axis L6 and can also move or articulate relative to thelongitudinal axis L6. The top portion 1144 can move or translaterelative to the bottom portion 1218 in a direction transverse to thelongitudinal axis L6. By allowing the multiplanar bone anchor system1200 to move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 1200 as necessary to conform to theanatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1200 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 1100 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1200 will not be discussed in great detail herein. Briefly,however, once the bone fastener 1102 is secured to the anatomy, thesaddle 1208 can be moved, pivoted or rotated relative to the bonefastener 1102 into the desired alignment for the fixation procedure.Once the aligned, the connecting rod 20 can be inserted into a desirednumber of multiplanar bone anchor systems 1200.

With the connecting rod 20 positioned in the saddles 1208 of themultiplanar bone anchor systems 1200, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1208. The coupling of the setscrew 22 to the saddle 1208 can apply a force to the lock ring 1104 tofixedly couple or lock the position of the bone fastener 1102 relativeto the saddle 1208.

With reference now to FIGS. 54-57 , in one example, a multiplanar boneanchor system 1300 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1300 can be similar to the multiplanar bone anchor system 1100 describedwith reference to FIGS. 46-49 , only the differences between themultiplanar bone anchor system 1100 and the multiplanar bone anchorsystem 1300 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1300 can include the bonefastener 1102, a lock ring 1304, a multiplanar coupling arrangement orsystem 1306, a saddle 1308 and a coupling device 1310. The multiplanarbone anchor system 1300 can define a longitudinal axis L7, and themultiplanar bone anchor system 1300 can be configured such that the bonefastener 1102 and the saddle 1308 can move relative to the longitudinalaxis L7 in multiple planes.

With reference to FIGS. 55-57 , the lock ring 1304 can be positionedabout the head 1110 of the bone fastener 1102. As will be discussedherein, the lock ring 1304 can lock at least one of the bone fastener1302 and the multiplanar coupling system 1306 relative to the saddle1308 via a force applied by the connecting rod 20. The lock ring 1304can be generally cylindrical, and can have a height H6. The height H6can be sized to extend above the receiver surface 88 of the saddle 1308so that coupling the connecting rod 20 to the saddle 1308 can compressthe lock ring 1304 onto the head 1110 of the bone fastener 1102 (FIG. 54). With reference to FIG. 55 , the lock ring 1304 can include a proximalend 1311, a distal end 1312 and the bore 1116.

The proximal end 1311 can bear against the connecting rod 20 when theconnecting rod 20 is coupled to the saddle 1308. The proximal end 1311can include a plurality of teeth 1311 a. The teeth 1311 a can engage orbite into the connecting rod 20 to assist in coupling the connecting rod20 to the saddle 1308. It should be noted, that the teeth 1311 a areoptional.

The distal end 1312 can include a collar 1314. The collar 1314 canextend about a circumference of the lock ring 1304 and can be positioneda distance above a distalmost surface 1304 a of the lock ring 1304. Thecollar 1314 can be in contact with the connecting arm 1316 and a portionof the saddle 1308. The collar 1314 can include at least one flatsurface 1315.

The at least one flat surface 1315 can contact the connecting arm 1316to assist in coupling the lock ring 1304 to the connecting arm 1316. Inone example the at least one flat surface 1315 can comprise three flatsurfaces 1315 a-1315 c, which can be spaced about a perimeter of thecollar 1314 of the lock ring 1304. The flat surfaces 1315 a-1315 c cancooperate with the connecting arm 1316 to enable the user to manipulatethe lock ring 1304 and the connecting arm 1316 to select a preferredangle, as will be described further herein. It should be noted thatalthough not illustrated herein, the lock ring 1304 could include thepreferred angle tab to mate with a preferred angle slot as describedwith regard to the multiplanar bone anchor system 1100.

With reference to FIGS. 55-57 , the multiplanar coupling system 1306 caninclude a connecting arm 1316. The connecting arm 1316 can be disposedabout the head 1110 of the bone fastener 1102 to enable the bonefastener 1102 to move or articulate relative to the saddle 1308. Theconnecting arm 1316 can be annular, and can be sized to receive aportion of the saddle 1308 and the lock ring 1304. With reference toFIG. 55 , the connecting arm 1316 can include a bore 1318 and an annularrecess 1320. The annular recess 1320 can receive a portion of the saddle1308 and the coupling device 1310 to couple the portion of the saddle1308 to the connecting arm 1316.

The bore 1318 can have a counterbored portion 1322 and a bearing surface1324. The counterbored portion 1322 can be formed near a proximalmostend 1316 a of the connecting arm 1316. The counterbored portion 1322 canreceive the collar 1314 of the lock ring 1304. The counterbored portion1322 can include at least one flat surface 1323. In one example, thecounterbored portion 1322 can include three flat surfaces 1323 a-132 c,which can cooperate with the flat surfaces 1315 a-1315 c of the lockring 1304 to couple the lock ring 1304 to the connecting arm 1316. Thebearing surface 1324 can contact the head 1110 of the bone fastener 1102to enable the bone fastener 1102 to move, rotate or articulate relativeto the connecting arm 1316.

With reference to FIGS. 54-57 , the saddle 1308 can include a firstportion or bottom portion 1326 and a second portion or top portion 1144.The top portion 1144 can move or translate relative to the bottomportion 1326. With reference to FIG. 55 , the bottom portion 1326 caninclude the first or proximal end 1146, a second or distal end 1328 anda bore 1330.

The distal end 1328 can include at least one coupling bore 1332 and acoupling recess 1334. In one example, the at least one coupling bore1332 can comprise two coupling bores 1332 a, 1332 b, as best illustratedin FIG. 57 . The coupling bores 1332 a, 1332 b can receive the couplingdevice 1310 to couple the connecting arm 1316 to the bottom portion1326. The coupling bores 1332 a, 1332 b can be positioned substantiallyopposite each other, and can generally extend in a direction transverseto the longitudinal axis L7. A portion of each of the coupling bores1332 a, 1332 b can be defined by the annular recess 1320 of theconnecting arm 1316. With reference to FIGS. 55 and 56 , the couplingrecess 1334 can be formed through a portion of the distal end 1328 andcan be generally elongate. The coupling recess 1334 can be positionedbetween the coupling bores 1332 a, 1332 b. The coupling recess 1334 canreceive a portion of the coupling device 1310 to enable the couplingdevice 1310 to be substantially flush with a surface of the bottomportion 1326 (FIG. 54 ).

The bore 1330 can be defined through the bottom portion 1326. The bore1330 can be sized to receive a portion of the lock ring 1304 and theconnecting arm 1316 therein (FIG. 56 ). The bore 1330 can have a firstdiameter at the proximal end 1146 and second diameter at a distal end1328. The diameter can be sized to receive the lock ring 1304therethrough, while the diameter can be sized to receive the bonefastener 1102, the lock ring 1304 and the connecting arm 1316.

With reference to FIG. 55 , the coupling device 1310 can be receivedthrough the coupling bores 1332 a, 1332 b and the coupling recess 1334.In one example, the coupling device 1310 can comprise a clip, such as aDutchman clip, however, any suitable device or technique could be usedto couple the connecting arm 1316 to the bottom portion 1326, such aspins, adhesives, mechanical fasteners, etc. The coupling device 1310 canbe substantially U-shaped, with a first arm 1336 and an opposed secondarm 1338. The first arm 1336 can be coupled to the second arm 1338 via abody 1340. The first arm 1336 and the second arm 1338 can include aflange at a distalmost end, if desired, which can engage a portion ofthe bottom portion 1326 to further secure the coupling device 1310within the bottom portion 1326 of the saddle 1308. The first arm 1336and the second arm 1338 can each be received through a respective one ofthe coupling bores 1332 a, 1332 b until the body 1340 is received withinand in contact with the coupling recess 1334 (FIG. 54 ).

With reference to FIG. 55 , in order to assemble the multiplanar boneanchor system 1300 according to one exemplary method, the bone fastener1102 can be inserted through the bore 1318 of the connecting arm 1316.Then, the bottom portion 1326 of the saddle 1308 can be positioned overthe connecting arm 1316 with the lock ring 1304 positioned over the head1110 of the bone fastener 1102 such that the connecting arm 1316 isreceived within the bore 1330 of the bottom portion 1326. The guides1162 a, 1162 b of the top portion 1144 can be slid onto the rails 1152a, 1152 b of the bottom portion 1326 to couple the top portion 1144 tothe bottom portion 1326. Next, the coupling device 1310 can be insertedthrough the coupling bores 1332 a, 1332 b until the body 1340 of thecoupling device 1310 is received within the coupling recess 1334 (FIG.54 ).

When assembled, the multiplanar bone anchor system 1300 can have atleast three degrees of movement or can be movable in at least threeplanes. In this regard, the bone fastener 1102 can move or rotate aboutthe longitudinal axis L7 and can also move or articulate relative to thelongitudinal axis L7. The top portion 1144 can move or translaterelative to the bottom portion 1326 in a direction transverse to thelongitudinal axis L7. By allowing the multiplanar bone anchor system1300 to move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 1300 as necessary to conform to theanatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1300 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1300 will not be discussed in great detail herein. Briefly,however, once the bone fastener 1102 is secured to the anatomy, thesaddle 1308 can be moved, pivoted or rotated relative to the bonefastener 1102 into the desired alignment for the fixation procedure.Once the aligned, the connecting rod 20 can be inserted into a desirednumber of multiplanar bone anchor systems 1300.

With the connecting rod 20 positioned in the saddles 1308 of themultiplanar bone anchor systems 1300, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1308. The coupling of the setscrew 22 to the saddle 1308 can apply a force to the lock ring 1304 tofixedly couple or lock the position of the bone fastener 1102 relativeto the saddle 1308.

With reference now to FIGS. 58-63 , in one example, a multiplanar boneanchor system 1400 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1400 can be similar to the multiplanar bone anchor system 1100 describedwith reference to FIGS. 46-49 , only the differences between themultiplanar bone anchor system 1100 and the multiplanar bone anchorsystem 1400 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1400 can include the bonefastener 1102, a lock ring 1404, a multiplanar coupling arrangement orsystem 1406 and a saddle 1408. The multiplanar bone anchor system 1400can define a longitudinal axis L8, and the multiplanar bone anchorsystem 1400 can be configured such that the bone fastener 1102 and thesaddle 1408 can move relative to the longitudinal axis L8 in multipleplanes (FIG. 58 ).

With reference to FIGS. 59-61 , the lock ring 1404 can be positionedabout the head 1110 of the bone fastener 1102. As will be discussedherein, the lock ring 1404 can lock at least one of the bone fastener1102 and the multiplanar coupling system 1406 relative to the saddle1408 via a force applied by the connecting rod 20. The lock ring 1404can be generally cylindrical, and can have a height H8. The height H8can be sized to extend above the receiver surface 88 of the saddle 1408so that coupling the connecting rod 20 to the saddle 1408 can compressthe lock ring 1404 onto the head 1110 of the bone fastener 1102 (FIG. 58). The lock ring 1404 can contact a portion of the saddle 1408 to limitthe motion of the saddle 1408, as will be discussed in greater detailherein. With reference to FIG. 59 , the lock ring 1404 can include aproximal end 1412, a distal end 1414, a slot 1416, at least one wing1418 and a bore 1420.

The proximal end 1412 can bear against the connecting rod 20 when theconnecting rod 20 is coupled to the saddle 1408. The distal end 1414 canbe adjacent to and in contact with the head 1110 of the bone fastener1102. The slot 1416 can extend from the proximal end 1412 to the distalend 1414. The slot 1416 can enable the lock ring 1404 to flex. The atleast one wing 1418 can engage a portion of the saddle 1408. In oneexample, the at least one wing 1418 can comprise two wings 1418 a, 1418b. The wings 1418 a, 1418 b can be positioned about 180° apart about thecircumference of the lock ring 1404. Each of the wings 1418 a, 1418 bcan include a base 1422 and an arm 1424. The base 1422 can couple thearm 1424 to the lock ring 1404. The base 1422 can be coupled between theproximal end 1412 and the distal end 1414, and the arm 1424 can extendfrom the base 1422 so as to be at or below a plane defined by the distalend 1414. The arm 1424 can have a flat portion 1424 a opposite a curvedportion 1424 b.

The flat portion 1424 a can aid in keeping the wings 1418 a, 1418 b incontact with the connecting arm 1430 and within a portion of the saddle1408, as illustrated in FIG. 61 . With reference to FIG. 62 , the curvedportion 1424 b can enable the lock ring 1404 to move or articulaterelative the connecting arm 1430 and the saddle 1408, which can therebyallow the bone fastener 1102 to move or articulate relative theconnecting arm 1430 and the saddle 1408, as will be discussed furtherherein.

With reference to FIG. 59 , the bore 1420 can be defined from theproximal end 1412 to the distal end 1414. The bore 1420 can enable aninstrument to engage the driver connection feature 34 when themultiplanar bone anchor system 1400 is assembled. The bore 1420 caninclude a bearing surface 1426. The bearing surface 1426 can generallybe formed adjacent to the distal end 1414. The bearing surface 1426 canbe arcuate and generally concave to slidably engage the spherical head1110 of the bone fastener 1102 (FIG. 61 ).

In one example, with reference to FIG. 59 , the multiplanar couplingsystem 1406 can include a connecting arm 1430. The connecting arm 1430can be disposed about the head 1110 of the bone fastener 1102 to enablethe bone fastener 1102 to move or articulate relative to the saddle1408, as shown in FIG. 63 . The connecting arm 1430 can be annular, andcan be sized to be received within a portion of the saddle 1408. Withreference to FIG. 59 , the connecting arm 1430 can include at least onepocket 1432 and a bore 1434.

The at least one pocket 1432 can be defined in a proximalmost end 1430 aof the connecting arm 1430. In one example, the at least one pocket 1432can comprise two pockets 1432 a, 1432 b. The pockets 1432 a, 1432 b canbe positioned about 180° apart about the circumference of the connectingarm 1430. The pockets 1432 a, 1432 b can be sized to receive arespective one of the wings 1418 a, 1418 b. The pockets 1432 a, 1432 bcan each define cut-outs, which extend for about 5° to about 25° aroundthe circumference of the connecting arm 1430. The pockets 1432 a, 1432 bcan have a depth sized to receive the arm 1425 of the wings 1418 a, 1418b. The depth can also be sized to enable the lock ring 1404 to move,pivot or rotate relative to the connecting arm 1430, as will bediscussed herein.

The bore 1434 can be defined through the connecting arm 1430, and canhave a chamfered surface 1436 and a bearing surface 1438. The chamferedsurface 1436 can provide clearance for the movement of the lock ring1404. The bearing surface 1438 can be defined adjacent to the chamferedsurface 1436. The bearing surface 1438 can be generally concave. Thebearing surface 1438 can contact the head 1110 of the bone fastener 1102to enable the bone fastener 1102 to move, rotate or articulate relativeto the connecting arm 1430.

With reference to FIGS. 58-61 , the saddle 1408 can include a firstportion or bottom portion 1440 and a second portion or top portion 1442.The top portion 1442 can move or translate relative to the bottomportion 1440. With reference to FIG. 59 , the bottom portion 1440 caninclude a first or proximal end 1444, a second or distal end 1446 and abore 1448. The proximal end 1444 can be generally rectangular, and caninclude rounded corners. It should be noted that the shape of theproximal end 1444 is merely exemplary, and the proximal end 1444 couldhave any selected shape, such as generally square, cylindrical, oval,etc. The proximal end 1444 can be coupled to the top portion 1442 (FIG.60 ). The proximal end 1444 can define at least one rail 1452.Generally, the top portion 1442 can move or translate along the at leastone rail 1452. In one example, the proximal end 1444 can define tworails 1452 a, 1452 b, which can be positioned on opposite sides of thebottom portion 1440. As will be discussed, the height H8 and/or diameterof the lock ring 1404 can define or limit the translation of the topportion 1442 relative to the bottom portion 1440. The distal end 1446can be adjacent to the shank 32 of the bone fastener 1102, when thesaddle 1408 is coupled to the bone fastener 1102. The bore 1448 can bedefined from the proximal end 1444 to the distal end 1446.

The bore 1448 can be sized to receive the connecting arm 1430 and thebone fastener 1102 therein. With reference to FIGS. 59 and 61 , the bore1448 can include at least one groove 1454, a bearing surface 1456 and atapered surface 1458. The at least one groove 1454 can be defined undera proximalmost surface 1444 a of the bottom portion 1440. In oneexample, the at least one groove 1454 can comprise two grooves 1454 a,1454 b. The two grooves 1454 a, 1454 b can each extend for about 90°about a circumference of the bore 1448, and can be positioned generally1800 apart from each other about the bore 1448. The grooves 1454 a, 1454b can receive the wings 1418 a, 1418 b of the lock ring 1404 to enablethe lock ring 1404 to move, rotate or pivot relative to the connectingarm 1430 and bottom portion 1440.

The bearing surface 1456 can be configured to receive the connecting arm1430 and can enable the connecting arm 1430 to move, rotate or pivotrelative to the bottom portion 1440. As best illustrated in FIG. 61 ,the tapered surface 1458 can provide clearance for the movement orarticulation of the bone fastener 1102 relative to the connecting arm1430 and the saddle 1408.

With reference to FIGS. 59 and 60 , the top portion 1442 of the saddle1408 can be coupled to the rails 1452 a, 1452 b of the proximal end 1444of the bottom portion 1440 so that the top portion 1442 can moverelative to the bottom portion 1440. The top portion 1442 can besubstantially U-shaped and symmetrical with respect to the longitudinalaxis L8 defined by the multiplanar bone anchor system 1400 (FIG. 58 ).The top portion 1442 can include a first or proximal end 1460 and asecond or distal end 1462. In one example, the proximal end 1460 caninclude a first arm 1464 and a second arm 1466. The first arm 1464 andsecond arm 1466 can extend upwardly from the distal end 1462 to definethe U-shape. Each of the first arm 1464 and the second arm 1466 caninclude the mating portion 84, the cavity 86 and a connector feature1468.

The connector feature 1468 can be defined in an exterior surface 1464 a.1466 a of the first arm 1464 and the second arm 1466. The connectorfeature 1468 can enable the multiplanar bone anchor system 1400 to becoupled to instrumentation, such as rod reduction instruments or to asuitable cross-connector device in a spinal fixation procedure. Theconnector feature 1468 is illustrated herein as comprising a triangularrecess formed in each of the first arm 1464 and the second arm 1466,however, it should be noted that the connector feature 1468 can have anyselected shape and dimension to cooperate with a selectedcross-connector device or instrument.

It should be noted that the lock ring 1404 can define or limit thetranslation of the top portion 1442 relative to the bottom portion 1440.In this regard, the cavity 86 can be defined in each interior surface1464 b, 1466 b of the first arm 1464 and second arm 1466 of the topportion 1442 of the saddle 1408. The cavity 86 can provide clearance forthe movement or articulation of the top portion 1442 relative to thebottom portion 1440 of the saddle 1408. Generally, the cavity 86 can bedefined so as to allow the top portion 1442 to move over a portion ofthe lock ring 1404, which can provide a range of motion for the topportion 1442 relative to the bottom portion 1440. Thus, contact betweenthe lock ring 1404 and the cavity 86 can act as a stop to limit themovement or translation of the top portion 1442 relative to the bottomportion 1440, however, other techniques could be used to stop or limitthe movement or translation of the top portion 1442 relative to thebottom portion 1440.

With reference to FIG. 59 , the distal end 1462 of the top portion 1442can be generally rectangular, and can include the first or a receiversurface 88, a second or bottom surface 1470 and a central bore 1472. Itshould be noted that the shape of the distal end 1442 does not have tobe generally rectangular, but could be generally square, cylindrical,oval, etc. The central bore 1472 can be defined through the distal end1462 from the receiver surface 88 to the bottom surface 1470.

The bottom surface 1470 can include at least one or more guides 1474. Inthis example, the bottom surface 1470 can include two guides 1474 a,1474 b. The guides 1474 a, 1474 b can slidably couple the top portion1442 to the bottom portion 1440. In this regard, each guide 1474 a, 1474b can cooperate with a respective one of the rails 1452 a, 1452 b toenable the top portion 1442 of the saddle 1408 to move or translaterelative to the bottom portion 1440 of the saddle 1408 (FIG. 60 ).Generally, each guide 1474 a, 1474 b can comprise a C-shape, and eachrail 1452 a, 1452 b can be received within a center of a respectiveguide 1474 a, 1474 b. It should be understood, however, that anysuitable shape could be used to enable the top portion 1442 to move ortranslate relative to the bottom portion 1440.

With reference to FIG. 59 , in order to assemble the multiplanar boneanchor system 1400 according to one exemplary method, the bone fastener1102 can be inserted through the bore 1434 of the connecting arm 1430until the bone fastener 1102 is seated within the connecting arm 1430.Then, bone fastener 1102 and the connecting arm 1430 can be insertedinto the bottom portion 1440 of the saddle 1408. The lock ring 1404 canbe inserted into the central bore 1472 of the top portion 1442. Therails 1452 a, 1452 b of the top portion 1442 can be slid onto the guides1452 a, 1452 b of the bottom portion 1440 (FIG. 60 ). Then, the lockring 1404 can be pushed downward and compressed until the wings 1418 a,1418 b are received within the grooves 1454 a, 1454 b of the bottomportion 1440 and the pockets 1432 a, 1432 b of the connecting arm 1430(FIG. 61 ).

When assembled, the multiplanar bone anchor system 1400 can have atleast three degrees of movement or can be movable in at least threeplanes. The bone fastener 1102 can move or rotate about the longitudinalaxis L8 and can also move or articulate relative to the longitudinalaxis L8. In this regard, with reference to FIGS. 62 and 63 , themultiplanar bone anchor system 1400 can enable the bone fastener 1102 toarticulate to a first preferred angle A6 (FIG. 61 ) and a secondpreferred angle A7 (FIGS. 62 and 63 ) relative to the longitudinal axisL8. The second preferred angle A7 can be greater than the secondpreferred angle A6. The first preferred angle A6 can be defined by thearticulation of the bone fastener 1102 relative to the connecting arm1430 (FIG. 61 ). The second preferred angle A7 can be defined by thearticulation of the connecting arm 1430 within the bottom portion 1440(FIGS. 62 and 63 ). It should be noted that the multiplanar bone anchorsystem 1400 need not include one or more preferred angles, if desired.

In this regard, the wings 1418 a, 1418 b of the lock ring 1404 canprevent the articulation of the connecting arm 1430 within the bottomportion 1440. In a plane perpendicular to the wings 1418 a, 1418 b,however, the connecting arm 1430 can be free to articulate relative tothe bottom portion 1440. This articulation of the connecting arm 1430within the bottom portion 1440 in the plane can define the secondpreferred angle A7. In addition, as the lock ring 1404 can move withinthe saddle 1408, the operator can move the lock ring 1404 to a desiredlocation to enable the selection of the location for the secondpreferred angle A5.

The top portion 1442 can also move or translate relative to the bottomportion 1440 in a direction transverse to the longitudinal axis L8. Byallowing the multiplanar bone anchor system 1400 to move in at leastthree planes, the surgeon can manipulate the multiplanar bone anchorsystem 1400 as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1400 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1400 will not be discussed in great detail herein. Briefly,however, once the bone fastener 1102 is secured to the anatomy, thesaddle 1408 can be moved, pivoted or rotated relative to the bonefastener 1102 into the desired alignment for the fixation procedure.Once the aligned, the connecting rod 20 can be inserted into a desirednumber of multiplanar bone anchor systems 1400.

With the connecting rod 20 positioned in the saddles 1408 of themultiplanar bone anchor systems 1400, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1408. The coupling of the setscrew 22 to the saddle 1408 can apply a force to the lock ring 1404 tofixedly couple or lock the position of the bone fastener 1102 relativeto the saddle 1408.

With reference now to FIGS. 64-71 , in one example, multiplanar boneanchor systems 1500 a, 1500 b can be employed with the connecting rod 20to repair a damaged portion of an anatomy. As the multiplanar boneanchor systems 1500 a, 1500 b can be similar to the multiplanar boneanchor system 800 described with reference to FIGS. 31-36 , only thedifferences between the multiplanar bone anchor system 800 and themultiplanar bone anchor systems 1500 a, 1500 b will be discussed ingreat detail herein, and the same reference numerals will be used todenote the same or similar components. The multiplanar bone anchorsystems 1500 a, 1500 b can include the bone fastener 802, a multiplanarcoupling arrangement or system 1504 a, 1504 b and a saddle 1506. Themultiplanar bone anchor system 1500 can define a longitudinal axis L9,and the multiplanar bone anchor system 1500 can be configured such thatthe bone fastener 802 and the saddle 1506 can move relative to thelongitudinal axis L9 in multiple planes.

In one example, with reference to FIGS. 65 and 69 , the multiplanarcoupling system 1504 a, 1504 b can include a connecting arm 1516 a, 1516b. The connecting arm 1516 a, 1516 b can be composed of any suitablebiocompatible material, such as a biocompatible metal, metal alloy,ceramic or polymer. The connecting arm 1516 a, 1516 b can be disposedabout the head 810 of the bone fastener 802 to allow relative movementbetween the bone fastener 802 and the saddle 806. The connecting arm1516 a, 1516 b can be sized to fit within the saddle 1506, and can alsoallow a portion of the saddle 1506 to move or translate relative toanother portion of the saddle 1506, as will be discussed in greaterdetail herein. The connecting arm 1516 a, 1516 b can include a first orupper portion 1520, a second or lower portion 1522 a, 1522 b and thebore 824.

The upper portion 1520 can be shaped to be received within a portion ofthe saddle 1506, and can be generally rectangular with rounded corners.In one example, the upper portion 1520 can have opposite curved features821. The opposite curved features 821 can include generally straightportions 821 a. The straight portion 821 a can cooperate with the saddle1506 to enable the saddle 806 to move or translate relative to the upperportion 1520 of the connecting arm 1516 a, 1516 b. The upper portion1520 can include the rail 829 as illustrated in FIGS. 67 and 71 .

With reference to FIGS. 65 and 69 , the lower portion 1522 a, 1522 b caninclude the connection surface 830 and a preferred angle slot 1532 a orpreferred angle slot 1532 b, respectively. Each of the preferred angleslots 1532 a, 1532 b can enable the bone fastener 802 to articulate to agreater angle A8 relative to a longitudinal axis L9 of the multiplanarbone anchor system 800. In this regard, with reference to FIGS. 67 and70 , the bone fastener 802 can generally articulate to an angle A9relative to the longitudinal axis L9 along the portion of the connectingarm 1516 a, 1516 b that does not include the preferred angle slot 1532a, 1532 b. At the location of the preferred angle slot 1532 a, 1532 b,the bone fastener 802 can generally articulate to the greater angle A8relative to the longitudinal axis L9. In one example, the angle A9 canbe about less than the greater angle A8, and the greater angle A8 can bebetween about 15 degrees and about 90 degrees. The preferred angle slot1532 a, 1532 b can comprise an arcuate cut-out defined through the lowerportion 1522 of the connecting arm 1516 a, 1516 b, which can be incommunication with the bore 824. The arcuate cut-out of the preferredangle slot 1532 a, 1532 b can enable the bone fastener 802 to move orarticulate to the greater angle A8 relative to the longitudinal axis L9.

In one example, as illustrated in FIGS. 64-67 , the preferred angle slot1532 a can be defined to enable the bone fastener 802 to articulate tothe greater angle A8 in a cephalad-caudal direction. In another example,as illustrated in FIGS. 68-71 , the preferred angle slot 1532 b can bedefined to enable the bone fastener 802 to articulate to the greaterangle A8 in a medial-lateral direction.

Further, it should be noted that although only one preferred angle slot1532 a, 1532 b is illustrated in the drawings for the multiplanar boneanchor systems 1500 a, 1500 b, the connecting arm 1516 a, 1516 b caninclude any number of preferred angle slots 1532 at any location alongthe connecting arm 1516 a, 1516 b to enable the bone fastener 802 toarticulate in any selected direction. It should also be noted that theshape of the cut-out that forms the preferred angle slot 1532 can bemodified to reduce or increase the greater angle A8 of the articulationof the bone fastener 802 relative to the longitudinal axis L9. Inaddition, it should be noted that the multiplanar bone anchor systems1500 a, 1500 b need not include one or more preferred angle slots, ifdesired.

With reference to FIGS. 65 and 69 , the saddle 1506 can be coupled tothe connecting arm 1516 a, 1516 b and can move or translate relative tothe connecting arm 1516 a, 1516 b. In this regard, the saddle 1506 caninclude a first portion or bottom portion 1538 and a second portion ortop portion 1542. The bottom portion 1538 can be immovably coupled tothe connecting arm 1516 a, 1516 b and the top portion 1542 can move ortranslate relative to the bottom portion 1538 and the connecting arm1516 a, 1516 b. In one example, the bottom portion 1538 can include theopposed generally arcuate surfaces 840 a, which can be interconnected bygenerally straight or flat surfaces 840 b. It should be noted that anysuitable geometry could be employed to enable the top portion 1542 tomove or translate relative to the bottom portion 1538. The shape of thebottom portion 1538 can correlate with the shape of the connecting arm1516 a, 1516 b. The bottom portion 1538 can include the first orproximal end 844, a second or distal end 1540 and the bore 848.

The distal end 1540 can include a preferred angle slot 1541 a, 1541 b.The preferred angle slot 1541 a, 1541 b can be defined through thedistal end 1540 so as to be in communication with the bore 848. In oneexample, as illustrated in FIGS. 64-67 , the preferred angle slot 1541 acan be defined to enable the bone fastener 802 to articulate to thegreater angle A8 in the cephalad-caudal direction. In another example,as illustrated in FIGS. 68-71 , the preferred angle slot 1541 b can bedefined to enable the bone fastener 802 to articulate to the greaterangle A8 in the medial-lateral direction. The preferred angle slot 1541a, 1541 b of the bottom portion 1538 can be positioned in substantiallythe same location relative to the connecting arm 1516 a, 1516 b suchthat when the bottom portion 1538 is coupled to the connecting arm 1516a, 1516 b, a respective one of the preferred angle slot 1541 a, 1541 bof the bottom portion 1538 is aligned with a respective one of thepreferred angle slot 1532 a, 1532 b of the connecting arm 1516 a, 1516b. The alignment between the preferred angle slot 1532 a, 1532 b and thepreferred angle slot 1541 a, 1541 b can enable the bone fastener 802 tomove or articulate to the greater angle A8.

With reference to FIGS. 67 and 71 , the top portion 1542 of the saddle1506 can be disposed about the curved features 821 of the connecting arm1516 a, 1516 b. The top portion 1542 can move or translate relative theconnecting arm 1516 a, 1516 b, and thus, move or translate relative tothe bottom portion 1538. The top portion 1542 can be substantiallyU-shaped and symmetrical with respect to a longitudinal axis L9 definedby the multiplanar bone anchor system 1500 a, 1500 b (FIGS. 64 and 68 ).With reference to FIGS. 65 and 69 , the top portion 1542 can include afirst or proximal end 1544 and a second or distal end 1546. In oneexample, the proximal end 1544 can include a first arm 1548 and a secondarm 1550. The first arm 1548 and second arm 1550 can extend upwardlyfrom the distal end 1546 to define the U-shape. Each of the first arm1548 and the second arm 1550 can include the mating portion 84, thecavity 868 (FIGS. 67 and 71 ) and a connector feature 1552.

With reference to FIGS. 65 and 69 , the connector feature 1552 can bedefined in an exterior surface 1548 a, 1550 a of the first arm 1548 andthe second arm 1550. The connector feature 1552 can enable themultiplanar bone anchor system 1500 a, 1500 b to be coupled toinstrumentation, such as rod reduction instruments or to a suitablecross-connector device in a spinal fixation procedure. The connectorfeature 1552 is illustrated herein as comprising a recess formed in eachof the first arm 1548 and the second arm 1550, it should be noted thatthe connector feature 1552 can have any selected shape and dimension tocooperate with a selected cross-connector device or instrument.

With reference to FIGS. 65 and 69 , the distal end 1546 of the topportion 1542 can be generally rectangular, and can include roundedcorners to correspond with the shape of the bottom portion 1538. Itshould be noted that the shape of the distal end 1546 does not have tobe generally rectangular, but rather could be generally square,cylindrical, oval, etc. The distal end 1546 can include the first orreceiver surface 88, the second or bottom surface 872 and the centralbore 876.

With reference to FIGS. 65 and 69 , in order to assemble the multiplanarbone anchor system 1500 a, 1500 b according to one exemplary method, thebone fastener 802 can be inserted into the bore 824 of the connectingarm 1516 a, 1516 b so that the bone fastener 802 is retained within andcan articulate within the connecting arm 1516 a, 1516 b. Then, theconnecting arm 1516 a, 1516 b can be inserted into the top portion 1542of the saddle 1506. Generally, the connecting arm 1516 a, 1516 b can berotated about 90° around the main axis M1 of the connecting arm 1516 a,1516 b in order to insert the connecting arm 1516 a, 1516 b through thetop portion 1542. The connecting arm 1516 a, 1516 b can be rotated backabout 90° around the axis M1 until the curved features 821 and straightportions 821 a of the connecting arm 1516 a, 1516 b are engaged with thecurved features 880 and straight features 882 of the top portion 1542.Then, the bottom portion 1538 can be coupled to the connecting arm 1516a, 1516 b.

It should be noted that this assembly technique is merely exemplary, asthe multiplanar bone anchor systems 1500 a, 1500 b could be assembledaccording to various methods. For example, the connecting arm 1516 a.1516 b could be inserted into the saddle 1506, and then the bonefastener 802 could be inserted into connecting arm 1516 a, 1516 b. Then,the bottom portion 1538 can be coupled to the connecting arm 1516 a,1516 b.

Once assembled, the connecting arm 1516 a, 1516 b can enable the bonefastener 802 to move or rotate within the bore 824 of the connecting arm1516 a. 1516 b. The connecting arm 1516 a, 1516 b can also allow thebone fastener 802 to move or angulate relative to the longitudinal axisL9 of the multiplanar bone anchor system 1500 a, 1500 b.

In one example, the preferred angle slot 1532 a of the connecting arm1516 a can cooperate with the preferred angle slot 1540 a of the bottomportion 1538 to enable the bone fastener 802 to move or articulate tothe greater angle A8 in the calphalad-caudal direction. In anotherexample, the preferred angle slot 1532 b of the connecting arm 1516 bcan cooperate with the preferred angle slot 1540 b of the bottom portion1538 to enable the bone fastener 802 to move or articulate to thegreater angle A8 in the medial-lateral direction. In either example, thetop portion 1542 of the saddle 1506 can move or translate relative tothe bottom portion 1538 and connecting arm 1516 a, 1516 b to a selectedposition.

Thus, when assembled, the multiplanar bone anchor system 1500 a, 1500 bcan have at least three degrees of movement or can be movable in atleast three planes. For example, the bone fastener 802 can rotate aboutthe longitudinal axis L9. The bone fastener 802 can also pivot relativeto the longitudinal axis L9 in at least a first direction and a seconddirection. The saddle 1506 can translate relative to the longitudinalaxis L9. By allowing the multiplanar bone anchor system 1500 a, 1500 bto move in at least three planes, the surgeon can manipulate themultiplanar bone anchor system 1500 a, 1500 b as necessary to conform tothe anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1500 a, 1500 b in a fixation procedure can be similar to the surgicalinsertion and insertion of the multiplanar bone anchor system 10 in afixation procedure, the surgical insertion and use of the multiplanarbone anchor system 1500 a, 1500 b will not be discussed in great detailherein. Briefly, however, once the multiplanar bone anchor system 1500a, 1500 b is secured to the anatomy, the multiplanar coupling system1504 and the saddle 1506 can be moved, pivoted or rotated relative tothe bone fastener 802 into the desired alignment for the fixationprocedure. Once the aligned, the connecting rod 20 can be inserted intoa desired number of multiplanar bone anchor systems 1500.

With the connecting rod 20 positioned in the saddles 1506 of themultiplanar bone anchor systems 1500 a, 1500 b, the set screw 22 can becoupled to each mating portion 84 of each saddle 1506. The coupling ofthe set screw 22 to the saddle 1506 can apply a force to the head 810 ofthe bone fastener 802 to fixedly couple or lock the position of the bonefastener 802 relative to the saddle 1506.

With reference now to FIGS. 72-75 , in one example, a multiplanar boneanchor system 1554 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1554 can be similar to the multiplanar bone anchor system 800 describedwith reference to FIGS. 31-36 , only the differences between themultiplanar bone anchor system 800 and the multiplanar bone anchorsystem 1554 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1554 can include a bonefastener 1555, a multiplanar coupling arrangement or system 1556 and asaddle 1557. The multiplanar bone anchor system 1554 can define alongitudinal axis L12, and the multiplanar bone anchor system 1554 canbe configured such that the bone fastener 1555 and the saddle 1557 canmove relative to the longitudinal axis L12 in multiple planes.

With reference to FIGS. 72 and 73 , the bone fastener 1555 can beconfigured to engage the anatomy to couple the multiplanar bone anchorsystem 1554 to the anatomy. The bone fastener 1555 can be composed ofany suitable biocompatible material, such as titanium, stainless steel,biocompatible metals, metal alloys, polymers, etc. The bone fastener1555 can include a proximal end or head 1558 (FIG. 73 ) and the distalend or shank 32. In one example, the head 1558 can be larger than thehead 810 of the multiplanar bone anchor system 800, and the larger head1558 can be coupled to and received within the saddle 1557. It shouldalso be noted that the shank 32 illustrated herein is merely exemplary,as the shank 32 could have any desired length or thread. With referenceto FIG. 73 , the head 1558 can include a first or upper portion 1559 andthe second or lower portion 814.

The upper portion 1559 can include the contact surface 815 and a driverconnection feature 1559 a. The driver connection feature 1559 a cancomprise any mating connection interface for a driver, such as apentalobe, hexalobe, hexagon, torx, Philips, cruciate, straight, etc. Inone example, the driver connection feature 1559 a can comprise apentalobe, and the contact surface 815 can be formed on the driverconnection feature 1559 a.

With continued reference to FIG. 73 , in one example, the multiplanarcoupling system 1556 can include a connecting arm 1560. The connectingarm 1560 can be composed of any suitable biocompatible material, such asa biocompatible metal, metal alloy or polymer. The connecting arm 1560can be disposed about the head 1558 of the bone fastener 1555 to allowrelative movement between the bone fastener 1555 and the saddle 1557.The connecting arm 1560 can be sized to fit within the saddle 1557, andcan also allow a portion of the saddle 1557 to move or translaterelative to another portion of the saddle 1557, as will be discussed ingreater detail herein. The connecting arm 1560 can include a first orupper portion 1561, a second or lower portion 1562, the bore 824 and atleast one slot 1563.

The upper portion 1561 can be shaped to be received within a portion ofthe saddle 1557, and can be generally rectangular with rounded corners.In one example, the upper portion 1561 can have the opposite curvedfeatures 821. The opposite curved features 821 can include generallystraight portions 821 a. The straight portion 821 a can cooperate withthe saddle 1557 to enable the saddle 1557 to move or translate relativeto the upper portion 1561 of the connecting arm 1560. The upper portion1561 can include the rail 829 as illustrated in FIG. 75 .

With reference to FIG. 73 , the lower portion 1562 can include aconnection surface 1564. The connection surface 1564 can comprise atleast one flat surface 1565 and at least one rib 1566. The at least oneflat surface 1565 and at least one rib 1566 can cooperate with a portionof the saddle 1557 to couple that portion of the saddle 1557 immovablyto the connecting arm 1560. In one example, the connection surface 1564can comprise two flat surfaces 1565 a, 1565 b and two ribs 1566 a, 1566b. The flat surfaces 1565 a, 1565 b can be substantially opposite eachother about a perimeter of the connecting arm 1560. The flat surfaces1565 a, 1565 b can prevent the connecting arm 1560 from rotatingrelative to the portion of the saddle 1557. The ribs 1566 a, 1566 b canbe formed along arcuate surfaces of the lower portion 1562 and cangenerally be positioned a distance from a bottommost surface 1562 a ofthe lower portion 1562 (FIG. 74 ). The ribs 1566 a, 1566 b can create anoverlap, interference or snap fit between the portion of the saddle 1557and the lower portion 1562, as will be discussed in greater detailherein.

With reference to FIG. 73 , the at least one slot 1563 can be definedthrough the upper portion 1561 and the lower portion 1562. The at leastone slot 1563 can enable the connecting arm 1560 to expand to accept thebone fastener 1555. In this regard, the at least one slot 1563 canenable the connecting arm 1560 to expand to except a larger sized headof a bone fastener, such as the head 1558 of the bone fastener 1555,without requiring the use of a larger sized connecting arm 1560 andsaddle 1557. In addition, the at least one slot 1563 can enable theconnecting arm 1560 to expand to accept the bone fastener 1555 after theconnecting arm 1560 is retained within the saddle 1557 from a bottomloading position, as will be discussed in greater detail herein. Itshould be noted that any suitable technique can be used to couple thebone fastener 1555 to the saddle 1557 from a bottom loading position,such as freezing the head 1558 of the bone fastener 1555 so that itcontracts and heating the connecting arm 1560 so that it expands toaccept the head 1558.

With reference to FIGS. 73 and 74 , the saddle 1557 can be coupled tothe connecting arm 1560 and can move or translate relative to theconnecting arm 1560. In this regard, the saddle 1557 can include a firstportion or bottom portion 1567 and a second portion or top portion 1568.The bottom portion 1567 can be immovably coupled to the connecting arm1560, and the top portion 1568 can move or translate relative to thebottom portion 1567 and the connecting arm 1560.

In one example, with reference to FIG. 73 , the bottom portion 1567 caninclude the opposed generally arcuate surfaces 840 a, which can beinterconnected by the generally straight or flat surfaces 840 b. Theshape of the bottom portion 1567 can cooperate with the shape of theconnecting arm 1560 so that the bottom portion 1567 can be coupled tothe connecting arm 1560. The bottom portion 1567 can include the firstor proximal end 844, the second or distal end 846 and a bore 1567 a.

With reference to FIG. 74 , the bore 1567 a can be formed along thelongitudinal axis L12 from the proximal end 844 to the distal end 846.The bore 1567 a can be sized and configured to be immovably coupledabout the connecting arm 1560. With reference to FIG. 73 , the bore 1567a can include the chamfered edge 852 and at least one groove 1569.

The at least one groove 1569 can cooperate with the at least one rib1565 of the connecting arm 1560 to couple the bottom portion 1567 to theconnecting arm 1560 (FIG. 74 ). In one example, the bore 1567 a caninclude two grooves 1569 a, 1569 b. A respective one of each of thegrooves 1569 a, 1569 b can engage a respective one of each of the ribs1566 a, 1566 b, Generally, the grooves 1569 a, 1569 b can be configuredto enable the ribs 1566 a. 1566 b to snap-lit into the grooves 1569 a,1569 b to couple the bottom portion 1567 with the connecting arm 1560.

With reference to FIG. 75 , the top portion 1568 of the saddle 1557 canbe disposed about the curved features 821 of the connecting arm 1560.The top portion 1568 can move or translate relative the connecting arm1560, and thus, move or translate relative to the bottom portion 1567.With reference to FIG. 72 , the top portion 1568 can be substantiallyU-shaped and symmetrical with respect to a longitudinal axis L12 definedby the multiplanar bone anchor system 1554. The top portion 1568 caninclude a first or proximal end 1570 and a second or distal end 1571. Inone example, with reference to FIG. 73 , the proximal end 1570 caninclude a first arm 1572 and a second arm 1573. The first arm 1572 andsecond arm 1573 can extend upwardly from the distal end 1571 to definethe U-shape. Each of the first arm 1572 and the second arm 1573 caninclude the mating portion 84, a cavity 1574 and a connector feature1575.

With reference to FIGS. 73 and 74 , the cavity 1574 can be defined ineach interior surface 1572 a, 1573 a of the first arm 1572 and thesecond arm 1573. The cavity 1574 can provide clearance for the movementor articulation of the top portion 1568 relative to the bottom portion1567 of the saddle 1557. In this regard, the cavity 1574 can be definedso as to allow the top portion 1568 to move over the head 1558 of thebone fastener 1555, which can provide a range of motion for the topportion 1568 relative to the bottom portion 1567. Thus, contact betweenthe head 1558 of the bone fastener 1555 and/or the connecting arm 1560and the cavity 1574 can act as a stop to limit the movement ortranslation of the top portion 1568 relative to the bottom portion 1567,however, other techniques could be used to stop or limit the movement ortranslation of the top portion 1568 relative to the bottom portion 1567,such as features formed on the connecting arm 1560. In addition, thecavity 1574 can be sized to enable the connecting arm 1560 to expand toaccept a larger diameter head 1558 of the bone fastener 1555.

With reference to FIG. 73 , the connector feature 1575 can be defined inan exterior surface 1572 b, 1573 b of the first arm 1572 and the secondarm 1573. The connector feature 1575 can enable the multiplanar boneanchor system 1554 to be coupled to instrumentation, such as a rodreduction instrument, or a suitable cross-connector device in a spinalfixation procedure. The connector feature 1575 is illustrated herein ascomprising an oblong recess with rounded corners formed in each of thefirst arm 1572 and the second arm 1573, however, it should be noted thatthe connector feature 1575 can have any selected shape and dimension tocooperate with a selected cross-connector device or instrument.

With continuing reference to FIG. 73 , the distal end 1571 of the topportion 1568 can be generally rectangular, and can include roundedcorners to correspond with the shape of the bottom portion 1567. Thedistal end 1571 can include the first or receiver surface 88, a secondor bottom surface 1574 and the central bore 876.

With reference to FIG. 75 , the bottom surface 1574 can include at leastone guide 1577. In one example, the bottom surface 1574 can include twoguides 1577 a, 1577 b, which can be positioned opposite each other. Theguides 1577 a, 1577 b can allow the top portion 1568 to move ortranslate relative to the connecting arm 1560. The guides 1577 a, 1577 bcan retain the top portion 1568 on the connecting arm 1560 and can beconfigured to mate with the curved features 821 of the connecting arm1560. An end of each of the guides 1577 a, 1577 b can contact the rail829 to guide the movement of the top portion 1568 relative to theconnecting arm 1560.

With reference to FIG. 73 , in order to assemble the multiplanar boneanchor system 1554 according to one exemplary method, the connecting arm1560 can be inserted into the central bore 876 of the saddle 1557.Generally, the connecting arm 1560 can be rotated about 90° around amain axis of the connecting arm 1560 in order to insert the connectingarm 1560 through the top portion 1568. The connecting arm 1560 can berotated back about 90° around the main axis until the curved features821 are engaged with the guides 1577 a, 1577 b of the top portion 1568.Then, the bone fastener 1555 can be inserted through the bore 824 of theconnecting arm 1560. The at least one slot 1563 in the connecting arm1560 and the size of the cavity 1574 can enable the connecting arm 1560to expand to accept the head 1558 of the bone fastener 1555. Then, thebottom portion 1567 can be coupled to the connecting arm 1560.

Once assembled, with reference to FIGS. 72-74 , the connecting arm 1560can enable the bone fastener 1555 to move or rotate within the bore 824of the connecting arm 1560. The connecting arm 1560 can also allow thebone fastener 1555 to move or angulate relative to the longitudinal axisL12 of the multiplanar bone anchor system 1554. The top portion 1568 ofthe saddle 1557 can move or translate relative to the bottom portion1567 and connecting arm 1569 to a selected position. Thus, whenassembled, the multiplanar bone anchor system 1554 can have at leastthree degrees of movement or can be movable in at least three planes.For example, the bone fastener 1555 can rotate about the longitudinalaxis L12. The bone fastener 1555 can also pivot relative to thelongitudinal axis L12 in at least a first direction and a seconddirection. The saddle 1557 can translate relative to the longitudinalaxis L12. By allowing the multiplanar bone anchor system 1554 to move inat least three planes, the surgeon can manipulate the multiplanar boneanchor system 1554 as necessary to conform to the anatomy of thepatient.

As the surgical insertion and use of the multiplanar bone anchor system1554 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1554 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 1554 is secured to theanatomy, the multiplanar coupling system 1556 and the saddle 1557 can bemoved, pivoted or rotated relative to the bone fastener 1555 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be inserted into a desired number of multiplanarbone anchor systems 1554.

With the connecting rod 20 positioned in the saddles 1557 of themultiplanar bone anchor systems 1554, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1557. The coupling of the setscrew 22 can apply a force to the head 1558 of the bone fastener 1555 tofixedly couple or lock the position of the bone fastener 1555 relativeto the saddle 1557.

With reference now to FIGS. 76-80 , in one example, a multiplanar boneanchor system 1580 can be employed with the connecting rod 20 to repaira damaged portion of an anatomy. As the multiplanar bone anchor system1580 can be similar to the multiplanar bone anchor system 1554 describedwith reference to FIGS. 72-75 , only the differences between themultiplanar bone anchor system 1554 and the multiplanar bone anchorsystem 1580 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1580 can include the bonefastener 1555, a multiplanar coupling arrangement or system 1581 and thesaddle 1557. The multiplanar bone anchor system 1580 can define alongitudinal axis L13, and the multiplanar bone anchor system 1580 canbe configured such that the bone fastener 1555 and the saddle 1557 canmove relative to the longitudinal axis L13 in multiple planes.

With reference to FIG. 77 , in one example, the multiplanar couplingsystem 1581 can include a connecting arm 1583. The connecting arm 1583can be composed of any suitable biocompatible material, such as abiocompatible metal, metal alloy or polymer. The connecting arm 1583 canbe disposed about the head 1558 of the bone fastener 1555 to allowrelative movement between the bone fastener 1555 and the saddle 1557.The connecting arm 1583 can be sized to fit within the saddle 1557, andcan also allow a portion of the saddle 1557 to move or translaterelative to another portion of the saddle 1557, as will be discussed ingreater detail herein. The connecting arm 1583 can include the first orupper portion 1561, a second or lower portion 1584, the bore 824 and theat least one slot 1563.

With reference to FIGS. 77 and 78 , the lower portion 1584 can includethe connection surface 1564 and at least one preferred angle slot 1585.In one example, the preferred angle slot 1585 can comprise a twopreferred angle slots 1585 a, 1585 b. The preferred angle slots 1585 a,1585 b can enable the bone fastener 1555 to articulate to a greaterangle A13 relative to a longitudinal axis L13 of the multiplanar boneanchor system 1580. In this regard, with reference to FIG. 79 , the bonefastener 1555 can generally articulate to an angle A14 relative to thelongitudinal axis L13 along the portion of the connecting arm 1583 thatdoes not include the preferred angle slots 1585 a, 1585 b. Withreference to FIG. 80 , at the location of the preferred angle slots 1585a, 1585 b, the bone fastener 1555 can generally articulate to thegreater angle A13 relative to the longitudinal axis L13. In one example,the angle A14 can be less than the greater angle A13, and the greaterangle A13 can be between about 15 degrees and 90 degrees. The preferredangle slots 1585 a, 1585 b can comprise an arcuate cut-out definedthrough the lower portion 1584 of the connecting arm 1583, which can bein communication with the bore 824. The arcuate cut-out of the preferredangle slots 1585 a, 1585 b can enable the bone fastener 1555 to move orarticulate to the greater angle A13 relative to the longitudinal axisL13.

It should be noted that although two preferred angle slots 1585 a, 1585b is illustrated in the drawings, the connecting arm 1583 can includeany number of preferred angle slots 1585 at any location along theconnecting arm 1583 to enable the bone fastener 1555 to articulate inany selected direction. It should also be noted that the shape of thecut-out that forms the preferred angle slots 1585 a, 1585 b can bemodified to reduce or increase the greater angle A13 of the articulationof the bone fastener 1555 relative to the longitudinal axis L13.

With reference to FIG. 77 , in order to assemble the multiplanar boneanchor system 1580 according to one exemplary method, the connecting arm1583 can be inserted into the central bore 876 of the saddle 1557.Generally, the connecting arm 1583 can be rotated about 90° around amain axis of the connecting arm 1583 in order to insert the connectingarm 1583 through the top portion 1568. The connecting arm 1583 can berotated back about 90° around the main axis until the curved features821 are engaged with the guides 1577 a, 1577 b of the top portion 1568.Then, the bone fastener 1555 can be inserted through the bore 824 of theconnecting arm 1583. The at least one slot 1563 in the connecting arm1583 and the size of the cavity 1574 can enable the connecting arm 1583to expand to accept the head 1558 of the bone fastener 1555. Then, thebottom portion 1567 can be coupled to the connecting arm 1560.

Once assembled, with reference to FIGS. 77, 79 and 80 , the connectingarm 1583 can enable the bone fastener 1555 to move or rotate within thebore 824 of the connecting arm 1583. The connecting arm 1583 can alsoallow the bone fastener 1555 to move or angulate relative to thelongitudinal axis L13 of the multiplanar bone anchor system 1580. Thepreferred angle slot 1585 of the connecting arm 1583 can enable the bonefastener 1555 to move or articulate to the greater angle A13. The topportion 1568 of the saddle 1557 can move or translate relative to thebottom portion 1567 and connecting arm 1583 to a selected position.Thus, when assembled, the multiplanar bone anchor system 1580 can haveat least three degrees of movement or can be movable in at least threeplanes. For example, the bone fastener 1555 can rotate about thelongitudinal axis L13. The bone fastener 1555 can also pivot relative tothe longitudinal axis L13 in at least a first direction and a seconddirection. The saddle 1557 can translate relative to the longitudinalaxis L13. By allowing the multiplanar bone anchor system 1580 to move inat least three planes, the surgeon can manipulate the multiplanar boneanchor system 1580 as necessary to conform to the anatomy of thepatient.

As the surgical insertion and use of the multiplanar bone anchor system1580 in a fixation procedure can be similar to the surgical insertionand insertion of the multiplanar bone anchor system 10 in a fixationprocedure, the surgical insertion and use of the multiplanar bone anchorsystem 1580 will not be discussed in great detail herein. Briefly,however, once the multiplanar bone anchor system 1580 is secured to theanatomy, the multiplanar coupling system 1581 and the saddle 1557 can bemoved, pivoted or rotated relative to the bone fastener 1555 into thedesired alignment for the fixation procedure. Once the aligned, theconnecting rod 20 can be inserted into a desired number of multiplanarbone anchor systems 1580.

With the connecting rod 20 positioned in the saddles 1557 of themultiplanar bone anchor systems 1580, the set screw 22 can be coupled toeach mating portion 84 of each saddle 1557. The coupling of the setscrew 22 can apply a force to the head 1558 of the bone fastener 1555 tofixedly couple or lock the position of the bone fastener 1555 relativeto the saddle 1557.

With reference now to FIGS. 81-84 , in one example, a lateral connector1600 can be employed with any one of the multiplanar bone anchor systems10, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300,1400, 1500 a, 1500 b, 1554, 1580 and can be coupled to the connectingrod 20 to repair a damaged portion of an anatomy. In an exemplaryprocedure, the lateral connector 1600 can be used to connect one of themultiplanar bone anchor systems 10, 100, 200, 300, 400, 500, 600, 700,800, 900, 1000, 1100, 1200, 1300, 1400, 1500 a, 1500 b, 1554, 1580 to alaterally spaced connecting rod 20. Generally, the lateral connector1600 can be coupled to each of the connecting rods 20 in a directiontransverse to a longitudinal axis of the connecting rods 20. The lateralconnector 1600 can include a body 1602 and an arm 1604. The lateralconnector 1600 can be composed of a suitable biocompatible material,such as a biocompatible metal or polymer.

With reference to FIGS. 82-84 , the body 1602 can include a main portion1605 and at least one translation assembly 1608. The main portion 1605can be substantially linear and cylindrical. The at least onetranslation assembly 1608 can be coupled to the main portion 1605.

The translation assembly 1608 can include a cylindrical housing 1610 anda locking device 1612. The cylindrical housing 1610 can be integrallyformed with the main portion 1605 if desired, or could be coupled to themain portion 1605 in a suitable post processing step, such as welding.With reference to FIG. 84 , the cylindrical housing 1610 can define across bore 1614 and a locking bore 1616. The cross bore 1614 can besized to receive a portion of the arm 1604. The locking bore 1616 can beconfigured to receive the locking device 1612, and can extend along anaxis transverse to an axis of the cross bore 1614. In one example, thelocking bore 1616 can include a plurality of threads 1616 a, which canengage a plurality of threads 1612 a associated with the locking device1612.

The locking device 1612 can include the plurality of threads 1612 a,which can mate with the plurality of threads 1616 a of the locking bore1616. In one example, the locking device 1612 can comprise a set screw,which can lock the arm 1604 to the body 1602.

The arm 1604 can include a rod 1618 and a hook 1620. It should be notedthat although the arm 1604 is described and illustrated herein asincluding a rod 1618 having an annular cross-section, the rod 1618 couldhave any shape, such as square. In this example, the rod 1618 can beconfigured to be slidably received in the cross bore 1614, and can becylindrical. As will be discussed, the rod 1618 can be movable relativeto the body 1602 to enable the lateral connector 1600 to adapt to avariety of patient anatomies. The rods 1618 can be coupled to the body1602 via pressure applied by the locking device 1612.

The hook 1620 can be coupled to the rod 1618, and in one example, thehook 1620 can be integrally formed with the rod 1618. Alternatively, thehook 1620 could be coupled to the rod 1618 in a suitable post processingstep. The hook 1620 can include a C-shaped cavity 1622 and a couplingdevice 1624. The C-shaped cavity 1622 can be configured to receive aconnecting rod 20. The coupling device 1624 can couple the connectingrod 20 to the C-shaped cavity 1622. In one example, with reference toFIG. 84 , the coupling device 1624 can comprise a set screw 1624 a,which can be threadably engaged with a threaded bore 1624 b. Theadvancement of the set screw 1624 a within the threaded bore 1624 b cancouple the lateral connector 1600 to the connecting rod 20.

With reference to FIGS. 81 and 84 , the lateral connector 1600 can beassembled by inserting the arm 1604 into the cross bore 1614. Then, thelocking device 1612 can be tightened to secure the arm 1604 to the body1602. The lateral connector 1600 can then be positioned so as to spanbetween an exemplary multiplanar bone anchor system 800 and a connectingrod 20. The hook 1620 of the arm 1604 can be coupled to the connectingrod 20 by tightening the set screw 1624 a and the arm 1604 can becoupled to the exemplary multiplanar bone anchor system 800 bytightening a set screw 22.

If, due to the patient's anatomy, the lateral connector 1600 is tooshort or too long, the arm 1604 can be moved or translated within thecross bore 1614 to enable the lateral connector 1600 to be coupled tothe connecting rod 20. For example, the locking device 1612 of thetranslation assembly 1608 can be loosened to enable the arm 1604 to moveto a desired position within the cross bore 1614 to extend a length ofthe lateral connector 1600 or to reduce the length of the lateralconnector 1600. This can allow the lateral connector 1600 to be usedwith a variety of differently sized patients.

With reference now to FIGS. 85 and 86 , in one example, a dominoconnector 1650 can be employed with any one of the multiplanar boneanchor systems 10, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000,1100, 1200, 1300, 1400, 1500 a, 1500 b, 1554, 1580 and can be coupled toone or more connecting rods 20 to repair a damaged portion of ananatomy. In an exemplary procedure, the domino connector 1650 can beused to impart rigidity to two vertically extending multiplanar boneanchor systems 10, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000,1100, 1200, 1300, 1400, 1500 a, 1500 b, 1554, 1580 having connectingrods 20. Generally, the domino connector 1650 can be coupled to each ofthe connecting rods 20 in a direction transverse to a longitudinal axisof the connecting rods 20.

The domino connector 1650 can include a movable body 1652 and at leastone connector 1654. The domino connector 1650 can be composed of asuitable biocompatible material, such as a biocompatible metal orpolymer. In one example, the domino connector 1650 can include twoconnectors 1654 a, 1654 b positioned on either end 1652 a, 1652 b of themovable body 1652.

The movable body 1652 can include a first portion 1656 and a secondportion 1658. The first portion 1656 can define a cross bore 1660 (FIG.86 ). The cross bore 1660 can receive the second portion 1658 so thatthe second portion 1658 can move or translate relative to the firstportion 1656. It should be noted that the second portion 1658 caninclude a stop, which can enable the second portion 1658 to move ortranslate relative to the first portion 1656 without disconnecting, ifdesired. Alternatively, a mechanical fastener or other technique couldbe used to movably secure the first portion 1656 to the second portion1658. The movement of the second portion 1658 relative to the firstportion 1656 can enable a length of the domino to increase or decreasein a medial-lateral direction depending upon the particular anatomy ofthe patient. It should be noted that the domino connector 1650 couldalso be configured to enable translation in a cephalad-caudal direction,if desired.

With continued reference to FIGS. 85 and 86 , the connectors 1654 a,1654 b can be coupled to a respective one of the connecting rods 20. Theconnectors 1654 a, 1654 b can each include a throughbore 1662 and alocking bore 1664. The throughbore 1662 can be sized to receive theconnecting rod 20, and can extend in a direction transverse to thelocking bore 1664. The locking bore 1664 can include threads 1664 a,which can be configured to receive a suitable locking device, such as aset screw, to couple the domino connector 1650 to the connecting rod 20.

The domino connector 1650 can be assembled by inserting a connecting rod20 through the throughbore 1662 of the connector 1654 a, and theninserting a connecting rod 20 through the throughbore 1662 of theconnector 1654 b. Then, the second portion 1658 can be slid into thefirst portion 1656. As the second portion 1658 is movable or slidablerelative to the first portion 1656, the length of the domino connector1650 can be sized during the procedure to correspond to the particularpatient's anatomy.

With reference now to FIGS. 87 and 88 , in one example, a multiplanarbone anchor system 1700 can be employed with the connecting rod 20 torepair a damaged portion of an anatomy. As the multiplanar bone anchorsystem 1700 can be similar to the multiplanar bone anchor system 800described with reference to FIGS. 31-36 , only the differences betweenthe multiplanar bone anchor system 800 and the multiplanar bone anchorsystem 1700 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar bone anchor system 1700 can include a bonefastener 1702 and a saddle 1704.

In one example, the bone fastener 1702 can comprise a bone hook having aC-shaped hook portion 1706 and a base 1708. The C-shaped hook portion1706 can be impacted into the anatomy to secure the C-shaped hookportion 1706 to the anatomy. In order to facilitate engagement of theC-shaped hook portion 1706 with the anatomy, the C-shaped hook portion1706 can include a tapered tip 1706 a. The C-shaped hook portion 1706can be positioned below the base 1708.

The base 1708 can couple the C-shaped hook portion 1706 to the saddle1704. The base 1708 can have a first end 1710 and a second end 1712. Thefirst end 1710 can be coupled to the C-shaped hook portion 1706. Thesecond end 1712 can be coupled to the base 1708. The first end 1710 canbe angled relative to the second end 1712, however, the first end 1710need not be angled relative to the second end 1712. The second end 1712can include at least one rail 1714. The at least one rail 1714 cancooperate with the saddle 1704 to enable the saddle 1704 to move ortranslate relative to the bone fastener 1702.

The saddle 1704 can be substantially U-shaped and symmetrical withrespect to a longitudinal axis L10 defined by the saddle 1704 (FIG. 88). The saddle 1704 can include a first or proximal end 1716 and a secondor distal end 1718. In one example, the proximal end 1716 can include afirst arm 1720 and a second arm 1722. The first arm 1720 and second arm1722 can extend upwardly from the distal end 1718 to define the U-shape.Each of the first arm 1720 and the second arm 1722 can include themating portion 84 and the connector feature 870.

With reference to FIGS. 87 and 88 , the distal end 1718 of the saddle1704 can be generally rectangular. It should be noted that the distalend 1718 can have any desired shape, such as generally square,cylindrical, oval, etc. The distal end 1718 can include the first orreceiver surface 88 and a second or bottom surface 1724. The bottomsurface 1724 can include at least one guide 1726. The at least one guide1726 can be coupled to the at least one rail 1714 to enable the saddle1704 to move or translate relative to the bone fastener 1702. It shouldbe noted that the movement or translation of the saddle 1704 relative tothe bone fastener 1702 need not be limited to a single direction, butrather, multiple rails and guides could be employed to enable movementor translation along multiple planes.

In order to assemble the multiplanar bone anchor system 1700, the saddle1704 can be slid onto the base 1708 so that the at least one guide 1726engages the at least one rail 1714. Then, in order to couple themultiplanar bone anchor system 1700 to the anatomy, with access providedto the anatomy, the C-shaped hook portion 1706 can be impacted into theanatomy to secure the multiplanar bone anchor system 1700 to theanatomy. Then, the saddle 1704 can be moved or translated relative tothe C-shaped hook portion 1706 into a selected position for receipt ofthe connecting rod 20. Once the connecting rod 20 is received within thesaddle 1704, the set screw 22 can be inserted into the mating portion 84of the first arm 1720 and second arm 1722 to couple the connecting rod20 to the multiplanar bone anchor system 1700.

With reference now to FIGS. 89-92 , in one example, a multiplanaroccipital plate seat 1750 can be employed with the connecting rod 20 torepair a damaged portion of an anatomy. As the multiplanar occipitalplate seat 1750 can be similar to the multiplanar bone anchor system 800described with reference to FIGS. 31-36 , only the differences betweenthe multiplanar bone anchor system 800 and the multiplanar occipitalplate seat 1750 will be discussed in great detail herein, and the samereference numerals will be used to denote the same or similarcomponents. The multiplanar occipital plate seat 1750 can include asaddle 1754.

The saddle 1754 can include a first portion or bottom portion 1756 and asecond portion or top portion 1758. The top portion 1758 can move ortranslate relative to the bottom portion 1756, as will be discussed ingreater detail herein. In one example, the bottom portion 1756 caninclude a first or proximal end 1760, a second or distal end 1762 and apin 1764. The proximal end 1760 can be coupled to the top portion 1758.The proximal end 1760 can include at least one rail 1766. In oneexample, the proximal end 1760 can include two rails 1766 a, 1766 b. Therails 1766 a, 1766 b can be positioned on opposed sides of bottomportion 1756 such that the rails 1766 a, 1766 b are about 180° apart.The rails 1766 a, 1766 b can be T-shaped, however, any shape could beemployed. The distal end 1762 can be generally rectangular with roundedcorners, and can be substantially planar.

The pin 1764 can extend from the bottom portion 1756 to couple thesaddle 1754 to an exemplary bone plate P. The pin 1764 can be generallysquare, but the pin 1764 could have any selected shape to couple thesaddle 1754 to the bone plate P.

The top portion 1758 of the saddle 1754 can be substantially U-shapedand symmetrical with respect to a longitudinal axis L11 defined by themultiplanar occipital plate seat 1750 (FIG. 89 ). The top portion 1758can include a first or proximal end 1767 and a second or distal end1768. In one example, the proximal end 1767 can include a first arm 1770and a second arm 1772. The first arm 1770 and second arm 1772 can extendupwardly from the distal end 1768 to define the U-shape. Each of thefirst arm 1770 and the second arm 1772 can include the mating portion84.

The distal end 1768 of the top portion 1758 can be generallyrectangular, and can include rounded corners to correspond with theshape of the bottom portion 1756. The distal end 1768 can include thefirst or receiver surface 88 and a guide 1774.

The guide 1774 can be configured to mate with the rails 1766 a, 1766 bof the bottom portion 1756. In one example, the guide 1774 can comprisea T-shape, however, any suitable shape could be employed to meet withthe rails 1766 a, 1766 b. The engagement of the guide 1774 with therails 1766 a, 1766 b can enable the top portion 1758 to move ortranslate relative to the bottom portion 1756.

In order to assemble the multiplanar occipital plate seat 1750, the topportion 1758 can be slid onto the bottom portion 1756 so that the guide1774 engages the rails 1766 a, 1766 b. Then, the pin 1764 of the bottomportion 1756 can be coupled to the bone plate P to couple the saddle1704 to the bone plate P. Once the bone plate P is positioned within theanatomy, the top portion 1758 can be moved relative to the bottomportion 1756 into a selected position for receipt of the connecting rod20. With the connecting rod 20 inserted between the first arm 1770 andthe second arm 1772, the set screw 22 can be inserted to couple theconnecting rod 20 to the multiplanar occipital plate seat 1750.

Accordingly, the multiplanar bone anchor system 10, 100, 200, 300, 400,500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500 a, 1500 b,1554, 1580 can be used to repair damaged tissue in the anatomy, such asin the case of a spinal fixation or fusion procedure. By allowing thebone fastener 12, 102, 302, 802, 952, 1002, 1102, 1555 and/or the saddle18, 106, 206, 308, 406, 506, 606, 806, 906, 956, 1006, 1106, 1108, 1308,1408, 1506, 1557 to move in multiple planes, but in a controlledfashion. In addition, the ability to manipulate the position of the bonefastener 12, 102, 302, 802, 952, 1002, 1102, 1555 and/or the saddle 18,106, 206, 308, 406, 506, 606, 806, 906, 956, 1006, 1106, 1108, 1308,1408, 1506, 1557 can enable the multiplanar bone anchor system 10, 100,200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, 1400,1500 a, 1500 b, 1554, 1580 to be used with a variety of differentanatomical structures.

While specific examples have been described in the specification andillustrated in the drawings, it will be understood by those of ordinaryskill in the art that various changes can be made and equivalents can besubstituted for elements thereof without departing from the scope of thepresent teachings. Furthermore, the mixing and matching of features,elements and/or functions between various examples is expresslycontemplated herein so that one of ordinary skill in the art wouldappreciate from the present teachings that features, elements and/orfunctions of one example can be incorporated into another example asappropriate, unless described otherwise, above. Moreover, manymodifications can be made to adapt a particular situation or material tothe present teachings without departing from the essential scopethereof. Therefore, it is intended that the present teachings not belimited to the particular examples illustrated by the drawings anddescribed in the specification, but that the scope of the presentteachings will include any embodiments falling within the foregoingdescription.

For example, while the multiplanar bone anchor system 1000 has beendescribed herein with reference to FIGS. 42-45 as including the saddle1006 having a bottom portion 1022 with rails 1032 a, 1032 b and a topportion 1024 with guides 1050 a, 1050 b, those of skill in the art willappreciate that the present disclosure, in its broadest aspects, may beconstructed somewhat differently. In this regard, with reference toFIGS. 93 and 94 , a saddle 1800 can include a first or top portion 1802,a second or middle portion 1804 and a third or bottom portion 1806. Thetop portion 1802 can include rails 1808 a, 1808 b. The rails 1808 a,1808 b can slidably engage guides 1810 a, 1810 b defined on a topsurface 1804 a of the middle portion 1804. A bottom surface 1804 b ofthe middle portion 1804 can include rails 1812 a. 1812 b, which canengage guides 1814 a, 1814 b formed on a top surface 1806 a of thebottom portion 1806. Thus, the saddle 1800 can have two dovetailconnections, which can allow for translation along a line or in atwo-dimensional plane. It should be noted that the rails 1808 a, 1808 b,1812 a, 1812 b can be orientated at any angle relative to a longitudinalaxis defined by the saddle 1800 to allow translation in any plane.

In this regard, translation along a single dovetail (ex. movement alongrails 1808 a, 1808 b and guides 1810 a, 1810 b or rails 1812 a, 1812 band guides 1814 a, 1814 b) allows for movement along a line oftranslation. Translation along both dovetails (e.g. movement along rails1808 a, 1808 b and guides 1810 a, 1810 b, and rails 1812 a, 1812 b andguides 1814 a, 1814 b) allows for movement along a two-dimensional planeof translation. It should be noted that the use of dovetail connectionsis merely exemplary, as any suitable connection mechanism could be usedto enable translation along a plane.

In another example, while the multiplanar bone anchor system 1000 hasbeen described herein with reference to FIGS. 42-45 as including thesaddle 1006 having a bottom portion 1022 with rails 1032 a, 1032 b and atop portion 1024 with guides 1050 a, 1050 b, those of skill in the artwill appreciate that the present disclosure, in its broadest aspects,may be constructed somewhat differently. In this regard, with referenceto FIGS. 95-97 , a saddle 1850 can include a first or top portion 1852,a second or middle portion 1854 and a third or bottom portion 1856. Thetop portion 1852 can include rails 1858 a, 1858 b, which can be formedalong a first arc. The rails 1858 a, 1858 b can slidably engage guides1860 a, 1860 b defined on a top surface 1854 a of the middle portion1854. The guides 1860 a, 1860 b can also be formed along the first arc.

A bottom surface 1854 b of the middle portion 1854 can also includerails 1862 a, 1862 b, which can be formed along a second arc. The rails1862 a, 1862 b can engage guides 1864 a, 1864 b formed on a top surface1856 a of the bottom portion 1856. The guides 1864 a, 1864 b can also beformed along the second arc (FIG. 99 ).

The first arc and the second arc can be orientated relative to eachother at any selected non-zero angle to enable three-dimensionalmovement of the saddle 1850. In addition, it should be noted that if thefirst arc and the second arc are sufficiently large, the movement couldapproximate planar motion. Further, it should be noted, that the use ofdovetail connections is merely exemplary, as any suitable connectionmechanism could be used to enable translation along a plane. Inaddition, it should be noted that the use of two arcs is merelyexemplary, as only one arc could be used, or an arc and a lineardovetail connection could be used.

In another of various examples, while the multiplanar bone anchor system1000 has been described herein with reference to FIGS. 42-45 asincluding a U-shaped top portion 1024 for receipt of a connecting rod 20that is translatable relative to a bone fastener 1002, those of skill inthe art will appreciate that the present disclosure, in its broadestaspects, may be constructed somewhat differently. In this regard, withreference to FIGS. 98 and 99 , a saddle 1900 can include a first or topportion 1902 movable relative to a bottom portion 1904. The top portion1902 can include a first half 1906, a second half 1908 and a lockingdevice 1910. The first half 1906 can include a first end 1914, a secondend 1916 and an opening 1918. The first end 1914 can be coupled to thelocking device 1910. The second end 1916 can include at least one guide1920, which can enable the top portion 1902 to move relative to thebottom portion 1904. The opening 1918 can be semi-circular andconfigured to receive a portion of the connecting rod 20 (FIG. 99 ). Theopening 1918 can be positioned between the first end 1914 and the secondend 1916.

The second half 1908 can include a first end 1922, a second end 1924 andan opening 1926. The first end 1922 can be coupled to the locking device1910. The second end 1924 can include at least one guide 1928, which canenable the top portion 1902 to move relative to the bottom portion 1904.The opening 1926 can be semi-circular and configured to receive aportion of the connecting rod 20 (FIG. 99 ). The opening 1926 can bepositioned between the first end 1922 and the second end 1924.

The locking device 1910 can be U-shaped, and can be positionable overthe first end 1914 of the first half 1906 and the first end 1922 of thesecond half 1908. The locking device 1910 can be positioned over thefirst half 1906 and the second half 1908 to retain the connecting rod 20within the openings 1918, 1926 (FIG. 99 ).

The bottom portion 1904 can include at least one rail 1930, which canenable both the first half 1906 and the second half 1908 to move ortranslate relative to the bottom portion 1904. The bottom portion 1904can also receive a bone fastener 1932 therethrough, which can move,rotate and/or articulate relative to the saddle 1900, if desired.

In use, the bottom portion 1904 can be coupled to the anatomy via thebone fastener 1932. Then, the first half 1906 and the second half 1908can be slidably engaged with the bottom portion 1904. The first half1906 and the second half 1908 can be slid about the connecting rod 20.Once the connecting rod 20 is received within the openings 1918, 1926,the locking device 1910 can be positioned over the first half 1906 andthe second half 1908 to secure the connecting rod 20 to the saddle 1900.

In another example, with reference to FIGS. 100 and 101 , a saddle 1950can be employed with the connecting rod 20 to repair a damaged portionof an anatomy. As the saddle 1950 can be similar to the saddle 1900described with reference to FIGS. 98 and 99 , only the differencesbetween the saddle 1900 and the saddle 1950 will be discussed in greatdetail herein, and the same reference numerals will be used to denotethe same or similar components. The saddle 1950 can include a first ortop portion 1952 movable relative to a bottom portion 1954. The topportion 1952 can include the second half 1908 and the locking device1910.

The bottom portion 1954 can include an arm 1956 and at least one rail1957 (FIG. 100 ). The arm 1956 can include an opening 1958 and a ledge1960. The opening 1958 can be semi-circular and configured to receive aportion of the connecting rod 20. The ledge 1960 can support a portionof the locking device 1910 to couple the connecting rod 20 to the saddle1950. The bottom portion 1904 can also receive a bone fastener 1962therethrough, which can move, rotate and/or articulate relative to thesaddle 1950, if desired.

In use, the bottom portion 1954 can be secured to the anatomy via thebone fastener 1962. Then, the second half 1908 can be slidably engagedwith the bottom portion 1954. The second half 1908 can be slid about theconnecting rod 20. Once the connecting rod 20 is received within theopenings 1926, 1958 the locking device 1910 can be positioned over thearm 1956 and the second half 1908 to secure the connecting rod 20 to thesaddle 1950 (FIG. 101 ).

In another of various examples, with reference to FIGS. 102 and 103 , asaddle 2000 can be employed with the connecting rod 20 to repair adamaged portion of an anatomy. As the saddle 2000 can be similar to thesaddle 1900 described with reference to FIGS. 98 and 99 , only thedifferences between the saddle 1900 and the saddle 2000 will bediscussed in great detail herein, and the same reference numerals willbe used to denote the same or similar components. The saddle 2000 caninclude a first or top portion 2002 movable relative to the bottomportion 1904.

The top portion 2002 can include a first half 2006, a second half 2008and the locking device 1910. The first half 2006 can include the firstend 1914, the second end 1916 and an opening 2010. The opening 2010 canbe semi-circular and elongated to receive a portion of the connectingrod 20 (FIG. 103 ). The elongated opening 2010 can enable the connectingrod 20 to move in the approximate medial-lateral direction. The opening2010 can be positioned between the first end 1914 and the second end1916.

The second half 2008 can include the first end 1922, the second end 1924and an opening 2012. The opening 2012 can be semi-circular and elongatedto receive a portion of the connecting rod 20 (FIG. 103 ). The elongatedopening 2012 can enable the connecting rod 20 to move in themedial-lateral direction. The opening 2012 can be positioned between thefirst end 1922 and the second end 1924.

In use, the bottom portion 1904 can be secured to the anatomy via thebone fastener 1932. Then, the first half 1906 and the second half 1908can be slidably engaged with the bottom portion 1904. The first half1906 and the second half 1908 can be slid about the connecting rod 20.Once the connecting rod 20 is received within the openings 2010, 2012,the locking device 1910 can be positioned over the first half 1906 andthe second half 1908 to secure the connecting rod 20 to the saddle 2000,while permitting the connecting rod 20 to move in a medial-lateraldirection (FIG. 103 ).

In another example, with reference to FIGS. 104 and 105 , a saddle 2020can be employed with the connecting rod 20 to repair a damaged portionof an anatomy. As the saddle 2020 can be similar to the saddle 1900described with reference to FIGS. 98 and 99 , only the differencesbetween the saddle 1900 and the saddle 2020 will be discussed in greatdetail herein, and the same reference numerals will be used to denotethe same or similar components. The saddle 2020 can include a first ortop portion 2022 movable relative to the bottom portion 1904.

With reference to FIG. 104 , the top portion 2022 can include a firsthalf 2026, a second half 2028 and the locking device 1910. The firsthalf 2026 can include the first end 1914, the second end 1916 and anopening 2030. The opening 2030 can be wedge-shaped to receive a portionof the connecting rod 20. The wedge-shaped opening 2030 can enable theopening 2030 to accept connecting rods 20 of varying diameters (FIG. 105). The opening 2030 can be positioned between the first end 1914 and thesecond end 1916.

With reference to FIG. 104 , the second half 2028 can include the firstend 1922, the second end 1924 and an opening 2032. The opening 2032 canbe wedge-shaped to receive a portion of the connecting rod 20. Thewedge-shaped opening 2032 can enable the opening 2032 to acceptconnecting rods 20 of varying diameters (FIG. 105 ). The opening 2032can be positioned between the first end 1914 and the second end 1916.

In use, the bottom portion 1904 can be secured to the anatomy via thebone fastener 1932. Then, the first half 1906 and the second half 1908can be slidably engaged with the bottom portion 1904. The first half1906 and the second half 1908 can be slid about the connecting rod 20.Once the connecting rod 20 is received within the openings 2030, 2032,the locking device 1910 can be positioned over the first half 1906 andthe second half 1908 to secure the connecting rod 20 to the saddle 2020(FIG. 105 ).

In addition, while the multiplanar bone anchor system 1000 has beendescribed herein with reference to FIGS. 42-45 as including the saddle1006 having a bottom portion 1022 with rails 1032 a, 1032 b and a topportion 1024 with guides 1050 a, 1050 b, those of skill in the art willappreciate that the present disclosure, in its broadest aspects, may beconstructed somewhat differently. In this regard, with reference toFIGS. 106 and 107 , a saddle 2050 can include a first or top portion2052 and a second or bottom portion 2054. The top portion 2052 caninclude guides 2052 a, 2052 b. The guides 2052 a, 2052 b can slidablyengage rails 2054 a, 2054 b defined on a top surface 2054 c of thebottom portion 2054.

The bottom portion 2054 can include the rails 2054 a, 2054 b and atleast one marking 2056 (FIG. 107 ). As discussed, the rails 2054 a, 2054b can cooperate with the guides 2052 a, 2052 b to enable the top portion2052 to move or translate relative to the bottom portion 2054. Withreference to FIG. 107 , the at least one marking 2056 can provide theoperator with a visual indicator of the presence or amount oftranslation of the top portion 2052 relative to the bottom portion 2054.

Thus, in use, with the bottom portion 2054 coupled to the anatomy via asuitable bone fastener, the operator can move or translate the topportion 2052 a selected amount based on a reading of the at least onemarking 2056 (FIG. 107 ).

In another of various examples, a translating fastener 3000 can be usedwith a plate, such as a bone plate B, to repair a damaged portion of ananatomy. In one example, with reference to FIGS. 108 and 109 , atranslating fastener 3000 can include a head 3002 and a shank 3004. Withreference to FIG. 109 , the head 3002 can include at least one T-shapedrail 3006. The T-shaped rail 3006 can be received within a pocket 3008defined in the shank 3004. One or more pins 3010 can be inserted betweenthe T-shaped rail 3006 and the pocket 3008. The one or more pins 3010can prevent the head 3002 from disassembling from the shank 3004, whileenabling the head 3002 to move relative to the shank 3004. The use ofthe T-shaped rail 3006 and the pocket 3008 is merely exemplary as anygeometry could be employed to enable the head 3002 to move relative tothe shank 3004. Further, the geometry employed could enable the head3002 to move relative to the shank 3004 in a line, plane, arc,two-dimensional path, three-dimensional path, etc. The movement betweenthe head 3002 and the shank 3004 can enable the translating fastener3000 to provide compression when used in a fixation procedure, such aswhen used with a cervical plate (FIG. 108 ).

It should be noted that the translation techniques described herein aremerely exemplary, as translation could be achieved through any suitabletechnique, such as the use of flexible materials, shape memorymaterials, springs, etc. Further, the various systems incorporating thetranslation techniques described and illustrated herein are merelyexemplary, as the translation techniques described herein could beapplied to top-loading bone screws, posted bone screws, closed bonescrews, polyaxial bone screws, uniplanar bone screws, fixed screws, etc.

What is claimed:
 1. A bone anchor comprising: a bone fastener includinga head and a shank; and a saddle including a first member and a secondmember that cooperate to define a bore that extends along a longitudinalaxis and is configured to receive the head of the bone fastener, thefirst member defining an opening that is configured to receive aconnecting rod, the second member being coupled to a distal end of thefirst member such that, when the head of the bone fastener is receivedwithin the bore, the second member prevents withdrawal of the head ofthe bone fastener from the bore through the distal end of the firstmember, the coupling between the first member and the second memberenabling translation of the first member relative to the second memberin a direction transverse to the longitudinal axis.
 2. The anchor ofclaim 1, further comprising a connecting arm disposed about the head ofthe bone fastener and captured within the bore of the saddle such thatthe first member is translatable relative to the second member and theconnecting arm in the direction transverse to the longitudinal axis. 3.The anchor of claim 2, wherein the connecting arm couples the secondmember to the distal end of the first member.
 4. The anchor of claim 2wherein the connecting arm engages an underside surface on the head ofthe bone fastener to prevent withdrawal of the head from the bore of thesaddle through the distal end of the first member.
 5. The anchor ofclaim 2, wherein the connecting arm includes a flange and the firstmember includes a shoulder that cooperates with the flange to enable thefirst member to translate relative to the second member and theconnecting arm in the direction transverse to the longitudinal axis. 6.The anchor of claim 5 wherein the shoulder of the first member engagesthe flange of the connecting arm to prevent withdrawal of the connectingarm from the bore of the saddle through the distal end of the firstmember.
 7. The anchor of claim 1 wherein the opening defined by thefirst member includes a pair of U-shaped slots, the connecting rodextending along the direction transverse to the longitudinal axis whenthe connecting rod is disposed in the U-shaped slots.
 8. The anchor ofclaim 1 wherein the first member defines internal threads configured toengage external threads on a set screw to couple the connecting rod tothe saddle.
 9. A bone anchor comprising: a bone fastener having a headincluding a first bearing surface; a connecting arm defining a firstbore extending along a longitudinal axis and having a second bearingsurface that cooperates with the first bearing surface of the bonefastener to enable the bone fastener to at least one of rotate and pivotrelative to the connecting arm; and a saddle having a first member and asecond member that cooperate to define a second bore that extends alongthe longitudinal axis, the connecting arm being received within thesecond bore and coupled to the second member, the first member beingcoupled to the second member such that the first member is translatablerelative to the second member and the connecting arm in a directiontransverse to the longitudinal axis.
 10. The anchor of claim 9, whereinthe connecting arm includes a preferred angle slot that defines apreferred angle for the bone fastener to articulate relative to thelongitudinal axis.
 11. The anchor of claim 10, wherein the preferredangle slot enables the bone fastener to articulate at a greater anglerelative to articulation of the bone fastener toward portions of theconnecting arm that do not include the preferred angle slot.
 12. Theanchor of claim 9, wherein the second member is immovably coupled to theconnecting arm.
 13. The anchor of claim 12 wherein the second memberdefines at least one groove and the connecting arm includes at least onerib that snap into the at least one groove to couple the second memberto the connecting arm.
 14. The anchor of claim 9 wherein the connectingarm includes opposed curved features that each has a straight portion,and the first member translates relative to the second member and theconnecting arm along the straight portions.
 15. The anchor of claim 9,wherein the connecting arm includes at least one rail and the firstmember includes at least one guide that contacts the at least one railto guide the translation of the first member relative to the connectingarm.
 16. A bone anchor comprising: a bone fastener having a headincluding a first bearing surface and extending along a longitudinalaxis; a connecting arm defining a first bore having a second bearingsurface that cooperates with the first bearing surface of the bonefastener to enable the bone fastener to at least one of pivot and rotaterelative to the connecting arm, the connecting arm including a firstpreferred angle slot that defines a preferred angle for the bonefastener to articulate relative to the longitudinal axis; and a saddlehaving a first member and a second member that cooperate to define asecond bore that extends along the longitudinal axis, the connecting armbeing received within the second bore and coupled to the second member,the second member being coupled to the first member such that the firstmember is translatable relative to the second member and the connectingarm in a direction transverse to the longitudinal axis.
 17. The anchorof claim 16, wherein the preferred angle slot enables the bone fastenerto articulate at a greater angle relative to articulation of the bonefastener toward portions of the connecting arm that do not include thepreferred angle slot.
 18. The anchor of claim 16 wherein the secondmember defines a pair of grooves and the connecting arm includes a pairof ribs that snap fit into the grooves to couple the second member tothe connecting arm.
 19. The anchor of claim 18, wherein the connectingarm includes a flange and the first member includes a pair of guidesthat cooperate with the flange to enable the first member to translaterelative to the second member and the connecting arm in the directiontransverse to the longitudinal axis.
 20. The anchor of claim 9, whereinthe connecting arm includes a pair of rails and each of the guidesincludes a lip that contacts the rails to guide the translation of thefirst member relative to the connecting arm.